Provider Demographics
NPI:1174084677
Name:FAMILY SERVICE OF CHAMPAIGN COUNTY
Entity type:Organization
Organization Name:FAMILY SERVICE OF CHAMPAIGN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-352-0099
Mailing Address - Street 1:405 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5129
Mailing Address - Country:US
Mailing Address - Phone:217-352-0099
Mailing Address - Fax:217-352-9512
Practice Address - Street 1:405 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5129
Practice Address - Country:US
Practice Address - Phone:217-352-0099
Practice Address - Fax:217-352-9512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SERVICE OF CHAMPAIGN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)