Healthcare Provider Details

I. General information

NPI: 1760931828
Provider Name (Legal Business Name): SINNISSIPPI CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JEFFERSON ST
OREGON IL
61061-1612
US

IV. Provider business mailing address

100 JEFFERSON ST
OREGON IL
61061-1612
US

V. Phone/Fax

Practice location:
  • Phone: 815-732-3157
  • Fax: 815-732-3834
Mailing address:
  • Phone: 815-732-3157
  • Fax: 815-732-3834

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 Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA A GOOD
Title or Position: VP/CFO
Credential: CPA
Phone: 815-284-6611