Provider Demographics
NPI:1154399780
Name:CHRISTIAN SOCIAL SERVICES OF ILLINOIS
Entity type:Organization
Organization Name:CHRISTIAN SOCIAL SERVICES OF ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUELSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-213-8705
Mailing Address - Street 1:8601 W MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1719
Mailing Address - Country:US
Mailing Address - Phone:618-394-5900
Mailing Address - Fax:618-394-5909
Practice Address - Street 1:8601 WEST MAIN STREET SUITE 201
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-1719
Practice Address - Country:US
Practice Address - Phone:618-397-5900
Practice Address - Fax:618-394-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 253J00000X, 261QM0801X
IL180025322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180025OtherDCFS CONTRACT #