Basic Information
| Provider Information | |||||||||
| NPI: | 1154571701 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHELBY COUNTY COMMUNITY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1810 W SOUTH 3RD ST | ||||||||
| Address2: | P.O. BOX 650 | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625659595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177745587 | ||||||||
| FaxNumber: | 2177745202 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E NORTH 12TH ST | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625659388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177741400 | ||||||||
| FaxNumber: | 2177741426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2008 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | COLCLASURE | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2177745587 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.