Healthcare Provider Details

I. General information

NPI: 1669019212
Provider Name (Legal Business Name): CASS COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E CENTRAL PARK PLZ
JACKSONVILLE IL
62650-2071
US

IV. Provider business mailing address

60 E CENTRAL PARK PLZ
JACKSONVILLE IL
62650-2071
US

V. Phone/Fax

Practice location:
  • Phone: 217-800-6622
  • Fax:
Mailing address:
  • Phone: 217-800-6622
  • 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: AMANDA BECHARD
Title or Position: BILLING AND CLAIMS SPECIALIST
Credential:
Phone: 217-323-2980