Provider Demographics
NPI:1962646042
Name:CASS COUNTY MENTAL HEALTH
Entity Type:Organization
Organization Name:CASS COUNTY MENTAL HEALTH
Other - Org Name:BRIDGEVIEW HOUSING
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-323-2980
Mailing Address - Street 1:7 BRIDGEVIEW
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-1069
Mailing Address - Country:US
Mailing Address - Phone:217-323-1239
Mailing Address - Fax:
Practice Address - Street 1:7 BRIDGEVIEW
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618
Practice Address - Country:US
Practice Address - Phone:217-323-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASS COUNTY MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-21
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1942316179Medicaid
IL77112Medicare UPIN