Healthcare Provider Details

I. General information

NPI: 1578664868
Provider Name (Legal Business Name): SINNISSIPPI CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 IL ROUTE 2
DIXON IL
61021-9118
US

IV. Provider business mailing address

3 OMALLEY CT
OHIO IL
61349-9533
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-6611
  • Fax: 815-284-6641
Mailing address:
  • Phone: 815-878-6689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. TERESA GOOD
Title or Position: VICE PRESIDENT
Credential: CFO
Phone: 815-284-6611