Provider Demographics
NPI:1407594120
Name:CHRISTIAN SOCIAL SERVICES OF ILLINOIS
Entity Type:Organization
Organization Name:CHRISTIAN SOCIAL SERVICES OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUELSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-213-8705
Mailing Address - Street 1:8601 W MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1719
Mailing Address - Country:US
Mailing Address - Phone:618-213-8700
Mailing Address - Fax:
Practice Address - Street 1:111 E 4TH ST STE 125
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6241
Practice Address - Country:US
Practice Address - Phone:618-468-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency