Healthcare Provider Details

I. General information

NPI: 1982928677
Provider Name (Legal Business Name): EFFINGHAM CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 06/23/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W FAYETTE AVE
EFFINGHAM IL
62401-2411
US

IV. Provider business mailing address

1625 W WASHINGTON ST
SPRINGFIELD IL
62702-4757
US

V. Phone/Fax

Practice location:
  • Phone: 217-857-1458
  • Fax: 217-857-1481
Mailing address:
  • Phone: 217-523-9201
  • Fax: 217-523-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number003973
License Number StateIL

VIII. Authorized Official

Name: STEVE ROACH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-523-9201