Healthcare Provider Details

I. General information

NPI: 1164751731
Provider Name (Legal Business Name): BCMW COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E REXFORD ST
CENTRALIA IL
62801-3033
US

IV. Provider business mailing address

909 E REXFORD ST
CENTRALIA IL
62801-3033
US

V. Phone/Fax

Practice location:
  • Phone: 618-532-3667
  • Fax:
Mailing address:
  • Phone: 618-532-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA SWANGO
Title or Position: CFO
Credential:
Phone: 618-532-3667