| Tazwood Mental Health Center, Inc. | |
|
124-126 S. Chicago Street Lincoln IL 62656 | |
| (217) 732-6865 | |
| (217) 732-7845 |
| Full Name | Tazwood Mental Health Center, Inc. |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 124-126 S. Chicago Street, Lincoln, Illinois |
| Authorized Official Name and Position | Dave Walter Mingus (CEO) |
| Authorized Official Contact | 3093475579 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tazwood Mental Health Center, Inc. 3248 Vandever Ave Pekin IL 61554-6257 Ph: (309) 347-5522 | Tazwood Mental Health Center, Inc. 124-126 S. Chicago Street Lincoln IL 62656 Ph: (217) 732-6865 |
| NPI Number | 1053633263 |
|---|---|
| Provider Enumeration Date | 02/16/2010 |
| Last Update Date | 07/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053633263 | NPI | - | NPPES |
| 949000 | Other | IL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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