Provider Demographics
NPI:1811659550
Name:SHAMROCK SERVICES GROUP
Entity type:Organization
Organization Name:SHAMROCK SERVICES GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LALLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-927-0290
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0017
Mailing Address - Country:US
Mailing Address - Phone:618-927-0290
Mailing Address - Fax:618-244-7704
Practice Address - Street 1:13023 N SHILOH DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-7391
Practice Address - Country:US
Practice Address - Phone:618-244-7701
Practice Address - Fax:618-244-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities