Healthcare Provider Details

I. General information

NPI: 1275862120
Provider Name (Legal Business Name): CATHOLIC SOCIAL SERVICES MT. VERNON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S 10TH ST
MOUNT VERNON IL
62864-4206
US

IV. Provider business mailing address

8601 W MAIN ST
BELLEVILLE IL
62223-1719
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-0344
  • Fax:
Mailing address:
  • Phone: 618-213-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number003967-11
License Number StateIL

VIII. Authorized Official

Name: GARY HUELSMANN
Title or Position: CEO
Credential:
Phone: 618-213-8700