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General NPI Number Information
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NPI Number | 1598031700
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Entity Type | Organization
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Legal Business Name | CHRISTIAN SOCIAL SERVICES OF ILLINOIS
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 214 S UNIVERSITY AVE
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City | CARBONDALE
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State | IL
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Zip | 62901-2925
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Country | US
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Telephone | 618-351-0743
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Fax | 618-351-0945
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Provider Business Mailing Address
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Address Line | 8601 W MAIN ST SUITE 201
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City | BELLEVILLE
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State | IL
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Zip | 62223-1719
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Country | US
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Telephone | 618-394-5900
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Fax | 618-394-5909
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GARY R HUELSMANN
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Credential | MSW
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Telephone | 618-394-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 003976-12
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License Number State | IL
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