Provider Demographics
NPI:1609835461
Name:YOUTH SERVICE BUREAU OF ILLINIOS VALLEY
Entity type:Organization
Organization Name:YOUTH SERVICE BUREAU OF ILLINIOS VALLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:SERVICE
Authorized Official - Last Name:VONCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-433-3953
Mailing Address - Street 1:424 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2833
Mailing Address - Country:US
Mailing Address - Phone:815-433-3953
Mailing Address - Fax:815-433-3980
Practice Address - Street 1:424 W MADISON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2833
Practice Address - Country:US
Practice Address - Phone:815-433-3953
Practice Address - Fax:815-433-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28089904251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1609835461Medicaid