Provider Demographics
NPI:1043851488
Name:WEST CENTRAL ILLINOIS NUTRITION
Entity type:Organization
Organization Name:WEST CENTRAL ILLINOIS NUTRITION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDM/CFPP
Authorized Official - Phone:217-592-3653
Mailing Address - Street 1:639 YORK ST. ROOM 333
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-592-3657
Mailing Address - Fax:217-592-3761
Practice Address - Street 1:639 YORK ST. ROOM 333
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-592-3657
Practice Address - Fax:217-592-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care