Provider Demographics
NPI:1245759273
Name:CENTRAL COUNTIES HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:CENTRAL COUNTIES HEALTH CENTERS, INC.
Other - Org Name:CENTRAL COUNTIES HEALTH CENTERS, INC. - FAMILY GUIDANCE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-788-2300
Mailing Address - Street 1:2239 E COOK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-1944
Mailing Address - Country:US
Mailing Address - Phone:217-788-2300
Mailing Address - Fax:217-788-2343
Practice Address - Street 1:120 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-1002
Practice Address - Country:US
Practice Address - Phone:217-788-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL COUNTIES HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)