Healthcare Provider Details

I. General information

NPI: 1154571701
Provider Name (Legal Business Name): SHELBY COUNTY COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 N MORGAN ST
SHELBYVILLE IL
62565-1672
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: 217-774-1400
  • Fax: 217-774-2256
Mailing address:
  • Phone: 217-774-5587
  • Fax: 217-774-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS COLCLASURE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-774-5587