Provider Demographics
NPI:1689166985
Name:CCSI-CASE COORDINATION LLC
Entity Type:Organization
Organization Name:CCSI-CASE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-698-0200
Mailing Address - Street 1:405 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2312
Mailing Address - Country:US
Mailing Address - Phone:217-698-0200
Mailing Address - Fax:217-698-9862
Practice Address - Street 1:70 E LAKE ST STE 1600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7446
Practice Address - Country:US
Practice Address - Phone:312-726-1364
Practice Address - Fax:312-726-1365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE SYSTEMS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management