Provider Demographics
NPI:1497050652
Name:FAMILY SERVICE CENTER OF SANGAMON COUNTY
Entity Type:Organization
Organization Name:FAMILY SERVICE CENTER OF SANGAMON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:217-528-8406
Mailing Address - Street 1:730 E. VINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703
Mailing Address - Country:US
Mailing Address - Phone:217-528-8406
Mailing Address - Fax:217-528-1446
Practice Address - Street 1:730 E. VINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703
Practice Address - Country:US
Practice Address - Phone:217-528-8406
Practice Address - Fax:217-528-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006840-13251S00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency