Healthcare Provider Details

I. General information

NPI: 1831213669
Provider Name (Legal Business Name): COLES COUNTY MENTAL HEALTH ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BROADWAY AVE E
MATTOON IL
61938-4610
US

IV. Provider business mailing address

750 BROADWAY AVE E
MATTOON IL
61938-4610
US

V. Phone/Fax

Practice location:
  • Phone: 217-238-5700
  • Fax:
Mailing address:
  • Phone: 217-238-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGIE WILLIAMS
Title or Position: ACCESS CENTER COORDINATOR
Credential: BA
Phone: 217-238-5735