|
| |
|
407 N Basin Rd Fairfield IL 62837-9639 | |
| (618) 273-3326 | |
| (618) 273-2808 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 407 N Basin Rd, Fairfield, Illinois |
| Authorized Official Name and Position | Angie Hampton (CEO) |
| Authorized Official Contact | 6182733326 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1412 Us Highway 45 N Eldorado IL 62930-3766 Ph: (618) 273-3326 | 407 N Basin Rd Fairfield IL 62837-9639 Ph: (618) 273-3326 |
| NPI Number | 1699242131 |
|---|---|
| Provider Enumeration Date | 11/01/2018 |
| Last Update Date | 05/28/2020 |
| Certification Date | 05/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699242131 | NPI | - | NPPES |
| 04051 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
Solutions Psychotherapy Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 206 W Sibley St, Fairfield, IL 62837 Phone: 618-599-3647 | |
Mt. Vernon Counseling Center, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 114 Andrews Dr, Fairfield, IL 62837 Phone: 312-841-7674 Fax: 618-270-0524 | |