Healthcare Provider Details

I. General information

NPI: 1528218179
Provider Name (Legal Business Name): SHELBY COUNTY COMMUNITY SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 W SOUTH 3RD ST
SHELBYVILLE IL
62565-9595
US

IV. Provider business mailing address

1810 W SOUTH 3RD ST P.O. BOX 650
SHELBYVILLE IL
62565-9595
US

V. Phone/Fax

Practice location:
  • Phone: 217-774-5587
  • Fax: 217-774-5202
Mailing address:
  • Phone: 217-774-5587
  • Fax: 217-774-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA HUBBARTT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-774-5587