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907 N Bluff Rd Suite 9 Collinsville IL 62234-5816 | |
| (618) 345-9644 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 907 N Bluff Rd, Collinsville, Illinois |
| Authorized Official Name and Position | Brionne Rhodes (DIRECTOR OF PROGRAMS) |
| Authorized Official Contact | 6183459644 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
333 S. Wabash Ave. Suite 2750 Chicago IL 60604-5816 Ph: (312) 949-5631 | 907 N Bluff Rd Suite 9 Collinsville IL 62234-5816 Ph: (618) 345-9644 |
| NPI Number | 1902161052 |
|---|---|
| Provider Enumeration Date | 07/05/2012 |
| Last Update Date | 08/08/2024 |
| Certification Date | 08/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902161052 | NPI | - | NPPES |
| 2A00IPI004 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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