MEDICARE: UNITED CEREBRAL PALSY OF SOUTHERN ILLINOIS,INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1518981299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY OF SOUTHERN ILLINOIS,INC.

Provider Business Mailing Address
First Line	:	9 CUSUMANO PROFESSIONAL PLAZA DR
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6736
Country	:	US
Telephone Number	:	618-244-2505
Fax Number	:	618-244-3568

Provider Business Practice Location Address
First Line	:	9 CUSUMANO PROFESSIONAL PLAZA DR
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6736
Country	:	US
Telephone Number	:	618-244-2505
Fax Number	:	618-244-3568

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHARON HALE
Credential	:
Telephone Number	:	618-244-2505

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/22/2020

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