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2023 Richview Rd Mount Vernon IL 62864-2884 | |
| (618) 242-1070 | |
| (618) 242-9381 |
| Full Name | |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 2023 Richview Rd, Mount Vernon, Illinois |
| Authorized Official Name and Position | Joe Bernard (INTERIM CEO / CFO) |
| Authorized Official Contact | 6182421070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2023 Richview Rd Mount Vernon IL 62864-2884 Ph: (618) 242-1070 | 2023 Richview Rd Mount Vernon IL 62864-2884 Ph: (618) 242-1070 |
| NPI Number | 1194036665 |
|---|---|
| Provider Enumeration Date | 06/29/2010 |
| Last Update Date | 11/10/2021 |
| Certification Date | 11/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194036665 | NPI | - | NPPES |
| 5000-IPI-029 | Medicaid | IL |
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