Healthcare Provider Details

I. General information

NPI: 1619331600
Provider Name (Legal Business Name): CASS COUNTY MENTAL HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 2ND ST
BEARDSTOWN IL
62618-1263
US

IV. Provider business mailing address

121 E 2ND ST
BEARDSTOWN IL
62618-1263
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-2980
  • Fax: 217-323-3731
Mailing address:
  • Phone: 217-323-2980
  • Fax: 217-323-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN JEAN HANCE
Title or Position: BILLING CLERK
Credential:
Phone: 217-323-2980