Provider Demographics
NPI:1356629133
Name:SINNISSIPPI CENTERS, INC.
Entity Type:Organization
Organization Name:SINNISSIPPI CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:815-284-6611
Mailing Address - Street 1:325 IL ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-9118
Mailing Address - Country:US
Mailing Address - Phone:815-284-6611
Mailing Address - Fax:815-284-2834
Practice Address - Street 1:1126 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1469
Practice Address - Country:US
Practice Address - Phone:815-244-4200
Practice Address - Fax:815-244-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2021-07-01
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)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL257331Medicare PIN
IL257330Medicare PIN