NPIMap

Organization Active NPI

Tazwood Mental Health Center, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lincoln, IL
National Provider Identifier
1053633263
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
TAZWOOD MENTAL HEALTH CENTER, INC.
Practice address
124-126 S. Chicago Street
Lincoln, IL 62656
Phone
(217) 732-6865
Fax
(217) 732-7845
NPI assigned
Feb 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Authorized official

Name
Dave Walter Mingus, LCPC
Title
Ceo
Phone
(309) 347-5579

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

124-126 S. Chicago Street
Lincoln, IL 62656

Mailing address

3248 Vandever Ave
Pekin, IL 61554-6257
Phone (309) 347-5522

Other identifiers 1

IdentifierTypeStateIssuer
949000OtherILMEDICARE

National Provider Directory

National Provider Directory
Tax ID family
Tazwood Mental Health Center14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

200 5th St
Ste 1
Lincoln, IL 62656
Phone (217) 732-6865

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1266278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1053633263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3248 VANDEVER AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546257",
            "telephone_number": "309-347-5522",
            "fax_number": "309-347-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124-126 S. CHICAGO STREET",
            "city": "LINCOLN",
            "state": "IL",
            "postal_code": "62656",
            "telephone_number": "217-732-6865",
            "fax_number": "217-732-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAZWOOD MENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-16",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "MINGUS",
        "authorized_official_first_name": "DAVE",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-347-5579",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "949000",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.