Provider Demographics
NPI:1437446861
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 1:100 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1612
Practice Address - Country:US
Practice Address - Phone:815-732-3157
Practice Address - Fax:815-732-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid
IL257330Medicare PIN
IL257331Medicare PIN