Provider Demographics
NPI:1598031700
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:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUELSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:618-394-5900
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 1:214 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2925
Practice Address - Country:US
Practice Address - Phone:618-351-0743
Practice Address - Fax:618-351-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL003976-12253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1275862120Medicaid
IL1942527536OtherTYPE 2-ORGANIZATION
IL1104156439Medicaid
IL1902973910Medicaid