Provider Demographics
NPI:1629379359
Name:PEORIA COUNTY COURT ADMINISTRATION
Entity Type:Organization
Organization Name:PEORIA COUNTY COURT ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT COURT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-677-6230
Mailing Address - Street 1:324 MAIN ST STE 215
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-2334
Mailing Address - Country:US
Mailing Address - Phone:309-677-6230
Mailing Address - Fax:309-672-6957
Practice Address - Street 1:324 MAIN ST STE 215
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-2334
Practice Address - Country:US
Practice Address - Phone:309-677-6230
Practice Address - Fax:309-672-6957
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEORIA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children