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1520 S 4th St Greenville IL 62246-2618 | |
| (618) 664-1455 | |
| (618) 664-1374 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1520 S 4th St, Greenville, Illinois |
| Authorized Official Name and Position | Sean Eifert (ADMINISTRATOR) |
| Authorized Official Contact | 6186641442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1520 S 4th St Greenville IL 62246-2618 Ph: (618) 664-1455 | 1520 S 4th St Greenville IL 62246-2618 Ph: (618) 664-1455 |
| NPI Number | 1437238177 |
|---|---|
| Provider Enumeration Date | 11/03/2006 |
| Last Update Date | 02/14/2020 |
| Certification Date | 02/14/2020 |
| Medicare PECOS PAC ID | 0446355820 |
|---|---|
| Medicare Enrollment ID | O20070412000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437238177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Hetal H Amin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083603872 PECOS PAC ID: 6305737008 Enrollment ID: I20040505000453 |
| Provider Name | Carrie J Ackerman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841327533 PECOS PAC ID: 4981709383 Enrollment ID: I20070413000027 |
| Provider Name | Jill R Engelmann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609108018 PECOS PAC ID: 4880724657 Enrollment ID: I20100605000081 |
| Provider Name | Sandra L Cania |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316441868 PECOS PAC ID: 2264795368 Enrollment ID: I20180423002255 |
| Provider Name | Sarah Hulbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477908614 PECOS PAC ID: 3971858358 Enrollment ID: I20180626003261 |
| Provider Name | Veronica B Schuster |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811256993 PECOS PAC ID: 3173967684 Enrollment ID: I20240222002858 |
| Provider Name | Connie J Goldsmith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922252584 PECOS PAC ID: 2466984034 Enrollment ID: I20241021002801 |
Jubilee House Outreach Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 417 W College Ave, Greenville, IL 62246 Phone: 618-664-2360 | |
Bond County Health Department Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1520 S 4th St, Greenville, IL 62246 Phone: 618-664-1455 Fax: 618-664-1744 | |
The Lighthouse Therapy Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 302 S 3rd St, Greenville, IL 62246 Phone: 618-699-5099 Fax: 618-493-4178 | |