| Springfield Group Home | |
|
401 W Springfield Ave Champaign IL 61820-4716 | |
| (217) 398-8080 | |
| Not Available |
| Full Name | Springfield Group Home |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 401 W Springfield Ave, Champaign, Illinois |
| Authorized Official Name and Position | Sheila Ferguson (CHIEF EXEC OFFICER) |
| Authorized Official Contact | 2173988080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Springfield Group Home 1801 Fox Dr Champaign IL 61820-7236 Ph: (217) 398-8080 | Springfield Group Home 401 W Springfield Ave Champaign IL 61820-4716 Ph: (217) 398-8080 |
| NPI Number | 1114174075 |
|---|---|
| Provider Enumeration Date | 08/22/2008 |
| Last Update Date | 09/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114174075 | NPI | - | NPPES |
| 1831167337 | Other | TRICARE | |
| 1831167337 | Other | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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