Provider Demographics
NPI:1245341684
Name:SANGAMON-MENARD ALCOHOLSIM AND DRUGS COUNCIL
Entity type:Organization
Organization Name:SANGAMON-MENARD ALCOHOLSIM AND DRUGS COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:217-544-9858
Mailing Address - Street 1:120 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-1002
Mailing Address - Country:US
Mailing Address - Phone:217-544-9858
Mailing Address - Fax:217-544-0223
Practice Address - Street 1:120 N 11TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-1002
Practice Address - Country:US
Practice Address - Phone:217-544-9858
Practice Address - Fax:217-544-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid