Basic Information
| Provider Information | |||||||||
| NPI: | 1588794317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRAIRIE CENTER HEALTH SYSTEMS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 W KILLARNEY ST | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618011015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173284500 | ||||||||
| FaxNumber: | 2172391129 | ||||||||
| Practice Location | |||||||||
| Address1: | 718 W KILLARNEY ST | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618011015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173284500 | ||||||||
| FaxNumber: | 2172391129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | RANEY | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2176933081 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | A-0606-0004-A | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | A-0606-0007-A | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 261QR0405X | A-0606-0001-A | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QR0405X | A-0606-0007-A | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 324500000X | A-0606-0002-A | IL | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QR0405X | A-0606-0004-A | IL | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 101YA0400X | A-0606-0001-A | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.