Provider Demographics
NPI:1528218179
Name:SHELBY COUNTY COMMUNITY SERVICE INC
Entity Type:Organization
Organization Name:SHELBY COUNTY COMMUNITY SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-774-5587
Mailing Address - Street 1:1810 W SOUTH 3RD ST
Mailing Address - Street 2:P.O. BOX 650
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-9595
Mailing Address - Country:US
Mailing Address - Phone:217-774-5587
Mailing Address - Fax:217-774-5202
Practice Address - Street 1:1810 W SOUTH 3RD ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-9595
Practice Address - Country:US
Practice Address - Phone:217-774-5587
Practice Address - Fax:217-774-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid