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101 Masonic Dr Murphysboro IL 62966-1959 | |
| (618) 242-6944 | |
| (618) 242-6726 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 101 Masonic Dr, Murphysboro, 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: () - | 101 Masonic Dr Murphysboro IL 62966-1959 Ph: (618) 242-6944 |
| NPI Number | 1255862611 |
|---|---|
| Provider Enumeration Date | 03/27/2017 |
| Last Update Date | 11/10/2021 |
| Certification Date | 11/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255862611 | NPI | - | NPPES |
| 5000-IPI-029 | Medicaid | IL |
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