Provider Demographics
NPI:1033340773
Name:HUMAN SERVICE CENTER
Entity Type:Organization
Organization Name:HUMAN SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-671-8089
Mailing Address - Street 1:PO BOX 1346
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61654-1346
Mailing Address - Country:US
Mailing Address - Phone:309-671-8005
Mailing Address - Fax:309-671-8021
Practice Address - Street 1:3500 W NEW LEAF LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3366
Practice Address - Country:US
Practice Address - Phone:309-689-3078
Practice Address - Fax:309-689-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA0324-0008-A261QR0405X
ILA03240008A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder