Basic Information
| Provider Information | |||||||||
| NPI: | 1437316023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMAN RESOURCES CENTER OF EDGAR AND CLARK COUNTIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1118 | ||||||||
| Address2: | 118 EAST COURT STREET | ||||||||
| City: | PARIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619445118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174654118 | ||||||||
| FaxNumber: | 2174631899 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 N 2ND ST | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624411075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174654118 | ||||||||
| FaxNumber: | 2174631899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2174654118 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 04072 | 01 | IL | DEPT OF HUMAN SERVICES | OTHER |