Healthcare Provider Details

I. General information

NPI: 1518045442
Provider Name (Legal Business Name): COMMUNITY LINK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 N 4TH ST
BREESE IL
62230-1791
US

IV. Provider business mailing address

1665 N 4TH ST
BREESE IL
62230-1791
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-8800
  • Fax: 618-526-2021
Mailing address:
  • Phone: 618-526-8800
  • Fax: 618-526-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN A HUELSKAMP
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 618-526-3905