Healthcare Provider Details

I. General information

NPI: 1255862611
Provider Name (Legal Business Name): SPERO FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MASONIC DR
MURPHYSBORO IL
62966-1959
US

IV. Provider business mailing address

2023 RICHVIEW RD
MOUNT VERNON IL
62864-2884
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-6944
  • Fax: 618-242-6726
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number021068-11
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE BERNARD
Title or Position: INTERIM CEO / CFO
Credential:
Phone: 618-242-1070