Provider Demographics
NPI:1659525863
Name:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Entity Type:Organization
Organization Name:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Other - Org Name:MEMORIAL BEHAVIORAL HEALTH - SPRINGFIELD RESIDENTIAL CENTER (BLDG B)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-588-2626
Mailing Address - Street 1:200 W LAKE DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4956
Mailing Address - Country:US
Mailing Address - Phone:217-588-7931
Mailing Address - Fax:217-529-9803
Practice Address - Street 1:200 W LAKE DR
Practice Address - Street 2:BUIDLING B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4956
Practice Address - Country:US
Practice Address - Phone:217-588-7931
Practice Address - Fax:217-529-9803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness