Provider Demographics
NPI:1598533523
Name:SOUTHERN ILLINOIS HARM REDUCTION NFP
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS HARM REDUCTION NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-554-6084
Mailing Address - Street 1:11336 COLLINS LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-4102
Mailing Address - Country:US
Mailing Address - Phone:618-554-6084
Mailing Address - Fax:
Practice Address - Street 1:8820 STATE ROUTE 1 STE 3
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-4897
Practice Address - Country:US
Practice Address - Phone:618-554-6084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health