Provider Demographics
NPI:1235455130
Name:COMMUNITY HEALTH IMPROVEMENT CENTER
Entity Type:Organization
Organization Name:COMMUNITY HEALTH IMPROVEMENT CENTER
Other - Org Name:COLES COUNTY COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-877-6111
Mailing Address - Street 1:2905 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-877-9117
Mailing Address - Fax:217-877-3077
Practice Address - Street 1:700 BROADWAY AVENUE EAST
Practice Address - Street 2:SUITE 39
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4662
Practice Address - Country:US
Practice Address - Phone:217-234-3091
Practice Address - Fax:217-234-3094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH IMPROVEMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-16
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141137Medicare Oscar/Certification