Provider Demographics
NPI:1952619199
Name:YWCA MCLEAN COUNTY
Entity Type:Organization
Organization Name:YWCA MCLEAN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-662-0461
Mailing Address - Street 1:1201 N HERSHEY RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3619
Mailing Address - Country:US
Mailing Address - Phone:309-662-0461
Mailing Address - Fax:309-662-4506
Practice Address - Street 1:1201 N HERSHEY RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3619
Practice Address - Country:US
Practice Address - Phone:309-662-0461
Practice Address - Fax:309-662-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6170401Medicaid