Champaign Treatment Center, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

CHAMPAIGN TREATMENT CENTER, LLC

Practice address

106 S Country Fair Dr Ste C
Champaign, IL 61821-3064

Phone

(217) 373-8200

NPI assigned

Sep 26, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce Jarvie

Title

VP, Treasurer

Phone

(214) 379-3300

Specialties & licenses 2

Addresses

Other names 1

• MedMark Treatment Centers Champaign Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Audrey Lynn Tanksley, MD

  • Internal Medicine Physician
  • Evergreen Park, IL
  • NPI 1750524518
  Medicare reassignment NPD
• Amy Bullington, MS, CADC

  • Addiction (Substance Use Disorder) Counselor
  • Champaign, IL
  • NPI 1639820749
  NPD
• Jennifer L Chandler

  • Addiction (Substance Use Disorder) Counselor
  • Champaign, IL
  • NPI 1821950379
  NPD
• Lynda Sue Curl, LPN

  • Licensed Practical Nurse
  • Champaign, IL
  • NPI 1265186100
  NPD
• Latarika L Dorris, LPN

  • Licensed Practical Nurse
  • Champaign, IL
  • NPI 1457092082
  NPD
• Sonja Marie Kovacev, RN

  • Addiction (Substance Use Disorder) Registered Nurse
  • Champaign, IL
  • NPI 1457106577
  NPD
• Hillary Lopez, LPN

  • Licensed Practical Nurse
  • Champaign, IL
  • NPI 1922757137
  NPD
• Celina R Wilson

  • Licensed Practical Nurse
  • Champaign, IL
  • NPI 1538914635
  NPD
• Kirk Donald Gohsman, ICADC, CRADC

  • Addiction (Substance Use Disorder) Counselor
  • Champaign, IL
  • NPI 1679850887
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785456000000",
    "number": "1033460498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 S COUNTRY FAIR DR",
            "address_2": "SUITE C",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618213063",
            "telephone_number": "217-373-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 S COUNTRY FAIR DR STE C",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618213064",
            "telephone_number": "217-373-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPAIGN TREATMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-26",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers Champaign",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Champaign Urbana Public Health Department
• Champaign Urbana Public Health District

• Substance Use Disorder Rehabilitation Clinic/Center in Champaign, IL
• Providers in Champaign, IL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.