Provider Demographics
NPI:1700187556
Name:ILLINOIS ASSOCIATION OF MICROBOARDS AND COOPERATIVES
Entity Type:Organization
Organization Name:ILLINOIS ASSOCIATION OF MICROBOARDS AND COOPERATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:NISWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-778-5388
Mailing Address - Street 1:104 WOODCREEK CT
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-9185
Mailing Address - Country:US
Mailing Address - Phone:217-778-5388
Mailing Address - Fax:217-586-4552
Practice Address - Street 1:104 WOODCREEK CT
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9185
Practice Address - Country:US
Practice Address - Phone:217-778-5388
Practice Address - Fax:217-586-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management