Provider Demographics
NPI:1851671556
Name:HUMAN SERVICES CENTER
Entity Type:Organization
Organization Name:HUMAN SERVICES CENTER
Other - Org Name:HUMAN SERVICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MIS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-282-6233
Mailing Address - Street 1:10257 STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-4418
Mailing Address - Country:US
Mailing Address - Phone:618-443-3045
Mailing Address - Fax:
Practice Address - Street 1:104 NORTHTOWN RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-1081
Practice Address - Country:US
Practice Address - Phone:618-282-6233
Practice Address - Fax:618-282-6949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
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
IL=========021OtherPROVIDER NUMBER