Organization · Type 2 NPI

Shawnee Health Service and Development Corp

Methadone Clinic · Carterville, IL

NPI number 1235780982 Active

Practice location

1006 S Division St
Carterville, IL 62918-1539

Call (618) 519-9200 Map

Fax (618) 985-3774

Mailing address

PO Box 577, 109 California St
Carterville, IL 62918-0577

Specialties and licenses

Taxonomy	Code	License
Methadone Clinic Primary	261QM2800X	None listed

Methadone Clinic: An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

17 other providers at this address

NPI record

NPI: 1235780982
Entity type: Organization (Type 2)
Issued: Sep 24, 2019
Last updated: Sep 24, 2019
Status: Active
Subpart: Yes of Shawnee Health Service and Development Corp

Other names

Shawnee Health Care, Carterville Sud · doing business as

Authorized official

Patsy R Jensen
CEO
(618) 956-9508

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1235780982

Shawnee Health Service and Development Corp's National Provider Identifier is 1235780982, issued on Sep 24, 2019. The primary taxonomy on file is Methadone Clinic (261QM2800X), and the practice location is in Carterville, IL. The record was last updated on Sep 24, 2019.