Healthcare Provider Details

I. General information

NPI: 1255499463
Provider Name (Legal Business Name): SOUTHERN SEVEN HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 RUSTIC CAMPUS DR
ULLIN IL
62992-2226
US

IV. Provider business mailing address

37 RUSTIC CAMPUS DR
ULLIN IL
62992-2226
US

V. Phone/Fax

Practice location:
  • Phone: 618-634-2297
  • Fax: 618-634-9011
Mailing address:
  • Phone: 618-634-2297
  • Fax: 618-634-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA ANDREWS-RAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 618-634-2297