Provider Demographics
NPI:1871378976
Name:CUNNINGHAM CHILDREN'S HOME OF URBANA IL
Entity type:Organization
Organization Name:CUNNINGHAM CHILDREN'S HOME OF URBANA IL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY IMPROVEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSW
Authorized Official - Phone:217-367-3728
Mailing Address - Street 1:701 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7337
Mailing Address - Country:US
Mailing Address - Phone:217-531-2360
Mailing Address - Fax:217-352-2635
Practice Address - Street 1:520 E WABASH AVE STE 1
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-3019
Practice Address - Country:US
Practice Address - Phone:217-531-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUNNINGHAM CHILDREN'S HOME OF URBANA IL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251V00000XAgenciesVoluntary or Charitable