Provider Demographics
NPI:1871615237
Name:WESTERN ILLINOIS SERVICE COORDINATION
Entity type:Organization
Organization Name:WESTERN ILLINOIS SERVICE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-833-1621
Mailing Address - Street 1:509 N LAFAYETTE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-7331
Mailing Address - Country:US
Mailing Address - Phone:309-833-1621
Mailing Address - Fax:309-837-1730
Practice Address - Street 1:509 N LAFAYETTE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-7331
Practice Address - Country:US
Practice Address - Phone:309-833-1621
Practice Address - Fax:309-837-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management