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General NPI Number Information
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NPI Number | 1598533523
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS HARM REDUCTION NFP
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 8820 STATE ROUTE 1 STE 3
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439-4897
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Country | US
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Telephone | 618-554-6084
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Fax |
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Provider Business Mailing Address
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Address Line | 11336 COLLINS LN
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City | LAWRENCEVILLE
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State | IL
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Zip | 62439-4102
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Country | US
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Telephone | 618-554-6084
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARCUS D HYRE
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Credential |
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Telephone | 618-554-6084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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