Healthcare Provider Details

I. General information

NPI: 1801425277
Provider Name (Legal Business Name): SINNISSIPPI CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S HENNEPIN AVE
DIXON IL
61021-3013
US

IV. Provider business mailing address

325 IL ROUTE 2
DIXON IL
61021-9118
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TERESA A GOOD
Title or Position: VP/CFO
Credential:
Phone: 815-284-6611