Provider Demographics
NPI:1821055658
Name:CUNNINGHAM CHILDREN'S HOME OF URBANA IL
Entity Type:Organization
Organization Name:CUNNINGHAM CHILDREN'S HOME OF URBANA IL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:217-367-3728
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-0878
Mailing Address - Country:US
Mailing Address - Phone:217-367-3728
Mailing Address - Fax:217-367-2896
Practice Address - Street 1:1301 N CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-1830
Practice Address - Country:US
Practice Address - Phone:217-367-3728
Practice Address - Fax:217-367-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid
IL=========-002Medicaid
IL=========-005Medicaid