| Salve Regina Center | |
|
1500 N 5th St Springfield IL 62702-2643 | |
| (217) 330-5773 | |
| Not Available |
| Full Name | Salve Regina Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1500 N 5th St, Springfield, Illinois |
| Authorized Official Name and Position | Melinda Osborn (OWNER) |
| Authorized Official Contact | 2173305773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salve Regina Center 1500 N 5th St Springfield IL 62702-2643 Ph: (217) 330-5773 | Salve Regina Center 1500 N 5th St Springfield IL 62702-2643 Ph: (217) 330-5773 |
| NPI Number | 1053040378 |
|---|---|
| Provider Enumeration Date | 06/10/2022 |
| Last Update Date | 01/24/2024 |
| Certification Date | 01/24/2024 |
| Medicare PECOS PAC ID | 5991142077 |
|---|---|
| Medicare Enrollment ID | O20240325003106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053040378 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Melinda Osborn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487009221 PECOS PAC ID: 7719332246 Enrollment ID: I20240325003208 |
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