Provider Demographics
NPI:1205338993
Name:TRANSITIONS OF WESTERN ILLINOIS INC.
Entity type:Organization
Organization Name:TRANSITIONS OF WESTERN ILLINOIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFORMATION SERVICES SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-223-0423
Mailing Address - Street 1:4409 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4409 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5849
Practice Address - Country:US
Practice Address - Phone:217-223-0413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)