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General NPI Number Information
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NPI Number | 1346451853
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Entity Type | Organization
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Legal Business Name | PARK PLACE CENTER
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 201 E MORGAN ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-2508
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Country | US
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Telephone | 217-245-1655
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Fax | 217-245-4742
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Provider Business Mailing Address
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Address Line | 201 E MORGAN ST P.O. BOX 1304
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City | JACKSONVILLE
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State | IL
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Zip | 62650-2508
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Country | US
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Telephone | 217-245-1655
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Fax | 217-245-4742
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ED J SCOTT
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Credential | L.C.S.W.
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Telephone | 217-245-1655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.003173
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License Number State | IL
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