Provider Demographics
NPI:1164730925
Name:MACON COUNTY COMMUNITY MENTAL HEALTH BOARD
Entity Type:Organization
Organization Name:MACON COUNTY COMMUNITY MENTAL HEALTH BOARD
Other - Org Name:CFC 19
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-423-6199
Mailing Address - Street 1:132 S WATER ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1332
Mailing Address - Country:US
Mailing Address - Phone:217-423-6199
Mailing Address - Fax:
Practice Address - Street 1:132 S WATER ST
Practice Address - Street 2:SUITE 604
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1332
Practice Address - Country:US
Practice Address - Phone:217-423-6199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency