TAZWOOD MENTAL HEALTH CENTER, INC. (NPI# 1760508907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760508907 |
| Entity Type | Organization |
| Organization Name | TAZWOOD MENTAL HEALTH CENTER, INC. |
| Other Organization Name | TMHC EP MH |
| Practice Address |
111 W. Washington Street Suite 230 East Peoria IL 61611 |
| Mailing Address |
3248 Vandever Ave Pekin IL 61554-6257 |
| Practice Telephone | 3096946462 |
| Practice Fax Number | 3096947812 |
| Mailing Telephone | 3093475579 |
| Mailing Fax Number | 3093474264 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2018-07-12 |
| Authorized Official Name | DAVE WALTER MINGUS (CEO) |
| Authorized Official Telephone | 3093475579 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| TMHC EP MH | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629444070 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 210 W. Walnut Street, Canton, IL 61520-2444 | 2015-08-19 |
| 1134464316 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 101 S. Major Street, Eureka, IL 61530 | 2012-11-29 |
| 1053633263 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 124-126 S. Chicago Street, Lincoln, IL 62656 | 2010-02-16 |
| 1013186683 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1421 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1568631133 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1425 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1356466007 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-20 |
| 1760958797 | Tazwood Mental Health Center, Inc. | Clinic/Center | 124 S Chicago St, Lincoln, IL 62656-2719 | 2018-10-17 |
| 1538540190 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 601 Taylor St, East Peoria, IL 61611 | 2015-06-09 |
| 1629247366 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1423 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1851417091 | Tazwood Mental Health Center, Inc. | Counselor | 3248 Vandever Ave, Pekin, IL 61554-6257 | 2007-03-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | TAZWOOD MENTAL HEALTH CENTER, INC. | 3248 Vandever Ave, Pekin, IL 61554-6257 |
| Street Address |
111 W. WASHINGTON STREET SUITE 230 |
| City | EAST PEORIA |
| State | IL |
| Zip Code | 61611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356466007 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548736390 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 133 Spinder Drive Ste 4015, East Peoria, IL 61611 | 2018-10-19 |
| 1083128474 | Abc Counseling & Family Services | Clinic/Center | 111 W. Washington St., Suite 410b, East Peoria, IL 61611 | 2017-11-22 |
| 1386162253 | Cheryl Denise Hagedorn | Speech-Language Pathologist | 306 Eckley Avenue, East Peoria, IL 61611 | 2017-08-31 |
| 1710342076 | Rebecca Uthe | Physical Therapist | 901 Illini Drive, East Peoria, IL 61611 | 2015-12-30 |
| 1669812103 | Christopher Webb | Dentist | 360 West Washington Street, East Peoria, IL 61611 | 2013-06-28 |
| 1386985380 | Dental Professionals of Illinois, P.C. | Dentist | 368 W. Washington St., East Peoria, IL 61611 | 2013-03-15 |
| 1730432675 | Synergy Healthcare Physical Medicine Sc | Chiropractor | 350 Cimmeron Drive, East Peoria, IL 61611 | 2012-10-16 |
| 1508122029 | Daniel Benjamin Gans | Radiology | 111 Oakwood Rd, East Peoria, IL 61611 | 2012-04-10 |
| 1326288390 | Sara Sabry Fouad Rizk | Pharmacist | 2540 East Washington Street, East Peoria, IL 61611 | 2009-03-03 |
| 1548315575 | Thomas R. Nalepka D.d.s | Dentist | 809 W Camp St, East Peoria, IL 61611 | 2007-01-23 |
| Find all providers in zip 61611 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083128474 | Abc Counseling & Family Services | Clinic/Center | 111 W. Washington St., Suite 410b, East Peoria, IL 61611 | 2017-11-22 |
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| Find all providers with the same taxonomy | ||||
| City | EAST PEORIA |
| Zip Code | 61611 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.