| NPI | 1205553195 |
|---|---|
| Doing Business As | SIU CENTER FOR HEALTHY AGING AND WELLNESS |
| Entity Type | Organization |
| Authorized Contact | IRIS WESLEY CEO 217-757-8137 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2025-01-09 |