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1528218179

NPI Code Detail

MEDICARE: SHELBY COUNTY COMMUNITY SERVICE INC

MEDICARE: SHELBY COUNTY COMMUNITY SERVICE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528218179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBY COUNTY COMMUNITY SERVICE INC

Provider Business Mailing Address
First Line	:	1810 W SOUTH 3RD ST
Second Line	:	P.O. BOX 650
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565-9595
Country	:	US
Telephone Number	:	217-774-5587
Fax Number	:	217-774-5202

Provider Business Practice Location Address
First Line	:	1810 W SOUTH 3RD ST
Second Line	:
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565-9595
Country	:	US
Telephone Number	:	217-774-5587
Fax Number	:	217-774-5202

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LINDA HUBBARTT
Credential	:
Telephone Number	:	217-774-5587

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	12/05/2008

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Directions to “SHELBY COUNTY COMMUNITY SERVICE INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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