MEDICARE: SINNISSIPPI CENTERS, 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	251V00000X	Voluntary or Charitable Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1922114115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SINNISSIPPI CENTERS, INC.

Provider Business Mailing Address
First Line	:	325 IL ROUTE 2
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-9118
Country	:	US
Telephone Number	:	815-284-6611
Fax Number	:	815-284-2834

Provider Business Practice Location Address
First Line	:	325 IL ROUTE 2
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-9118
Country	:	US
Telephone Number	:	815-284-6611
Fax Number	:	815-284-2834

Authorized Official
Title or Position	:	VP/CFO
Name	:	MRS. TERESA A GOOD
Credential	:	CPA
Telephone Number	:	815-284-6611

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/08/2018

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