Provider Demographics
NPI:1588817530
Name:CASS COUNTY MENTAL HEALTH
Entity type:Organization
Organization Name:CASS COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-323-2980
Mailing Address - Street 1:121 E 2ND ST
Mailing Address - Street 2:BEARDSTOWN
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-1263
Mailing Address - Country:US
Mailing Address - Phone:217-323-2980
Mailing Address - Fax:217-323-3731
Practice Address - Street 1:121 E 2ND ST
Practice Address - Street 2:BEARDSTOWN
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-1263
Practice Address - Country:US
Practice Address - Phone:217-323-2980
Practice Address - Fax:217-323-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2020-03-10
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
IL036075498Medicaid
IL932002OtherBLUE CROSS BLUE SHIELD
IL932002OtherBLUE CROSS BLUE SHIELD
IL=========001OtherFEIN