Healthcare Provider Details

I. General information

NPI: 1861758575
Provider Name (Legal Business Name): CHRISTIAN SOCIAL SERVICES OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W MAIN ST STE. 201
BELLEVILLE IL
62223-1719
US

IV. Provider business mailing address

8601 W MAIN ST SUITE 201
BELLEVILLE IL
62223-1719
US

V. Phone/Fax

Practice location:
  • Phone: 618-688-1161
  • Fax: 618-394-5900
Mailing address:
  • Phone: 618-688-1161
  • Fax: 618-394-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number003967-11
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: GARY HUELSMANN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 618-213-8705