| Human Service Center | |
|
228 Ne Jefferson Ave Peoria IL 61603-3802 | |
| (309) 671-8005 | |
| Not Available |
| Full Name | Human Service Center |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 228 Ne Jefferson Ave, Peoria, Illinois |
| Authorized Official Name and Position | Michael Kennedy (PRESIDENT/CEO) |
| Authorized Official Contact | 3096718005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Human Service Center Po Box 1346 Peoria IL 61654-1346 Ph: (309) 671-8005 | Human Service Center 228 Ne Jefferson Ave Peoria IL 61603-3802 Ph: (309) 671-8005 |
| NPI Number | 1578940557 |
|---|---|
| Provider Enumeration Date | 04/29/2015 |
| Last Update Date | 12/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578940557 | NPI | - | NPPES |
| 003240005 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 003240005 (Illinois) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | A-0324-0005-A (Illinois) | Primary |
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