NPIMap

Organization Active NPI

Arrowhead Ranch

  • Community Health Clinic/Center
  • Coal Valley, IL
National Provider Identifier
1407026511
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
ARROWHEAD RANCH
Practice address
12200 104TH St
Coal Valley, IL 61240-9712
Phone
(309) 799-7044
NPI assigned
Mar 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Dr. Chelease Machay Parks, ED. D.
Title
Director of State Programs
Phone
(309) 799-7044

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

12200 104TH St
Coal Valley, IL 61240-9712

Mailing address

12200 104TH St
P.O. Box 370
Coal Valley, IL 61240-9712
Phone (309) 799-7044

National Provider Directory

National Provider Directory
Tax ID family
Arrowhead Ranch3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1407026511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 104TH ST",
            "address_2": "P.O. BOX 370",
            "city": "COAL VALLEY",
            "state": "IL",
            "postal_code": "612409712",
            "telephone_number": "309-799-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 104TH ST",
            "city": "COAL VALLEY",
            "state": "IL",
            "postal_code": "612409712",
            "telephone_number": "309-799-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARROWHEAD RANCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "CHELEASE",
        "authorized_official_middle_name": "MACHAY",
        "authorized_official_title_or_position": "DIRECTOR OF STATE PROGRAMS",
        "authorized_official_telephone_number": "309-799-7044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED. D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coal Valley, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.