Healthcare Provider Details

I. General information

NPI: 1497050652
Provider Name (Legal Business Name): FAMILY SERVICE CENTER OF SANGAMON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E. VINE ST
SPRINGFIELD IL
62703
US

IV. Provider business mailing address

730 E. VINE ST
SPRINGFIELD IL
62703
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-8406
  • Fax: 217-528-1446
Mailing address:
  • Phone: 217-528-8406
  • Fax: 217-528-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number006840-13
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number006840-13
License Number StateIL

VIII. Authorized Official

Name: MS. JOSEPHINE E ROCCO
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A.
Phone: 217-528-8406