Provider Demographics
NPI:1740400597
Name:SARAH BUSH LINCOLN HEALTH CENTER
Entity Type:Organization
Organization Name:SARAH BUSH LINCOLN HEALTH CENTER
Other - Org Name:BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEAGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-258-2513
Mailing Address - Street 1:500 HEALTH CENTER DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 HEALTH CENTER DR
Practice Address - Street 2:SUITE 406
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9258
Practice Address - Country:US
Practice Address - Phone:217-258-4042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARAH BUSH LINCOLN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center