Provider Demographics
NPI:1003244724
Name:TAZWOOD MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:TAZWOOD MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-347-5579
Mailing Address - Street 1:3248 VANDEVER AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6257
Mailing Address - Country:US
Mailing Address - Phone:309-347-5579
Mailing Address - Fax:309-347-5579
Practice Address - Street 1:3248 VANDEVER AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6257
Practice Address - Country:US
Practice Address - Phone:309-347-5579
Practice Address - Fax:309-347-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health