Provider Demographics
NPI:1760562961
Name:CENTER FOR YOUR HEALTH LTD
Entity Type:Organization
Organization Name:CENTER FOR YOUR HEALTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MANTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-684-2419
Mailing Address - Street 1:501 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:IL
Mailing Address - Zip Code:61864
Mailing Address - Country:US
Mailing Address - Phone:217-684-2419
Mailing Address - Fax:217-684-2356
Practice Address - Street 1:501 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PHILO
Practice Address - State:IL
Practice Address - Zip Code:61864-9653
Practice Address - Country:US
Practice Address - Phone:217-684-2419
Practice Address - Fax:217-684-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214177OtherGROUP