Provider Demographics
NPI:1245524677
Name:LOCUST STREET RESOURCE CENTER
Entity type:Organization
Organization Name:LOCUST STREET RESOURCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-854-3166
Mailing Address - Street 1:320 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1648
Mailing Address - Country:US
Mailing Address - Phone:217-854-3166
Mailing Address - Fax:217-854-3778
Practice Address - Street 1:354 N PLUM ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1316
Practice Address - Country:US
Practice Address - Phone:217-854-3166
Practice Address - Fax:217-854-9729
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOCUST STREET RESOURCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-02
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness