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General NPI Number Information
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NPI Number | 1689166985
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Entity Type | Organization
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Legal Business Name | CCSI-CASE COORDINATION LLC
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 70 E LAKE ST STE 1600
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City | CHICAGO
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State | IL
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Zip | 60601-7446
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Country | US
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Telephone | 312-726-1364
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Fax | 312-726-1365
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Provider Business Mailing Address
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Address Line | 405 N MACARTHUR BLVD
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City | SPRINGFIELD
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State | IL
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Zip | 62702-2312
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Country | US
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Telephone | 217-698-0200
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Fax | 217-698-9862
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Authorized Official
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Title or Position | ADMINISTRATIVE PROGRAM MANAGER
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Name | MARY P HEMP
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Credential |
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Telephone | 217-698-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | IL
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