1548872278 NPI number — TRANSITIONS OF WESTERN ILLINOIS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548872278 NPI number — TRANSITIONS OF WESTERN ILLINOIS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSITIONS OF WESTERN ILLINOIS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548872278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3646
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62305-3646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-223-0423
Provider Business Mailing Address Fax Number:
217-223-0461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 S 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62301-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-223-0423
Provider Business Practice Location Address Fax Number:
217-223-0461
Provider Enumeration Date:
08/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
POTTER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
217-223-0423

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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