Provider Demographics
NPI:1184676330
Name:WEST CENTRAL ILLINOIS HOUSING ASSOCIATES, LP
Entity Type:Organization
Organization Name:WEST CENTRAL ILLINOIS HOUSING ASSOCIATES, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEWOHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-223-7904
Mailing Address - Street 1:639 YORK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3918
Mailing Address - Country:US
Mailing Address - Phone:217-592-3668
Mailing Address - Fax:217-592-3732
Practice Address - Street 1:639 YORK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3918
Practice Address - Country:US
Practice Address - Phone:217-592-3668
Practice Address - Fax:217-592-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid