Provider Demographics
NPI:1407126352
Name:SPRINGFIELD HOSPITAL, INC.
Entity Type:Organization
Organization Name:SPRINGFIELD HOSPITAL, INC.
Other - Org Name:LINCOLN PRAIRIE BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-585-1180
Mailing Address - Street 1:5230 S 6TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5128
Mailing Address - Country:US
Mailing Address - Phone:217-585-1180
Mailing Address - Fax:217-585-4747
Practice Address - Street 1:5230 S 6TH STREET RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5128
Practice Address - Country:US
Practice Address - Phone:217-585-1180
Practice Address - Fax:217-585-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490126391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149012639OtherLICENSED CLINICAL SOCIAL WORKER MASTERS