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General NPI Number Information
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NPI Number | 1477286516
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Entity Type | Organization
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Legal Business Name | LOCUST STREET RESOURCE CENTER
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 515 W CHERRY ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-1632
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Country | US
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Telephone | 217-854-3166
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Fax | 217-854-3778
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Provider Business Mailing Address
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Address Line | 320 S LOCUST ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-1648
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Country | US
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Telephone | 217-854-3166
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Fax |
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Authorized Official
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Title or Position | BILLING/CREDENTIALING
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Name | ELIZABETH SCHERER
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Credential |
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Telephone | 217-854-3166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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