Provider Demographics
NPI:1831635770
Name:COMMUNITY HEALTH IMPROVEMENT CENTER
Entity Type:Organization
Organization Name:COMMUNITY HEALTH IMPROVEMENT CENTER
Other - Org Name:CROSSING HEALTHCARE ON WATER ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-877-9117
Mailing Address - Street 1:320 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4665
Mailing Address - Country:US
Mailing Address - Phone:217-877-9117
Mailing Address - Fax:217-330-8770
Practice Address - Street 1:1027 N WATER ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1022
Practice Address - Country:US
Practice Address - Phone:217-330-5676
Practice Address - Fax:217-330-5992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH IMPROVEMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-17
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)