Provider Demographics
NPI:1871042937
Name:SINNISSIPPI CENTERS, INC.
Entity Type:Organization
Organization Name:SINNISSIPPI CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:815-284-6611
Mailing Address - Street 1:1122 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053-1461
Mailing Address - Country:US
Mailing Address - Phone:815-244-1376
Mailing Address - Fax:815-244-3074
Practice Address - Street 1:1122 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1461
Practice Address - Country:US
Practice Address - Phone:815-244-1376
Practice Address - Fax:815-244-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable