Provider Demographics
NPI:1225361769
Name:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Entity type:Organization
Organization Name:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-588-2626
Mailing Address - Street 1:200 W LAKE DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4956
Mailing Address - Country:US
Mailing Address - Phone:217-529-9775
Mailing Address - Fax:217-529-9803
Practice Address - Street 1:200 W LAKE DR
Practice Address - Street 2:BUILDING A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4956
Practice Address - Country:US
Practice Address - Phone:217-529-9775
Practice Address - Fax:217-529-9803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-16
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)