Provider Demographics
NPI:1558530691
Name:FAMILY PLANNING SERVICE OF WESTERN IL, INC.
Entity Type:Organization
Organization Name:FAMILY PLANNING SERVICE OF WESTERN IL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:309-343-6162
Mailing Address - Street 1:311 E MAIN ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-4855
Mailing Address - Country:US
Mailing Address - Phone:309-343-6162
Mailing Address - Fax:309-343-3802
Practice Address - Street 1:311 E MAIN ST
Practice Address - Street 2:SUITE 409
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4855
Practice Address - Country:US
Practice Address - Phone:309-343-6162
Practice Address - Fax:309-343-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20700000X251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE64456OtherUPIN
IL=========001Medicaid