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Organization
SOUTHERN ILLINOIS CENTER FOR INDEPENDENT LIVING
Active
Organization
SOUTHERN ILLINOIS CENTER FOR INDEPENDENT LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE VAUGHN (EXECUTIVE DIRECTOR)
(618) 457-3318
Entity
Organization
Contact information
Practice address
2135 W. RAMADA LANE, CARBONDALE, IL 62901-5326
(618) 457-3318
(618) 549-0132
Mailing address
2135 W. RAMADA LANE, CARBONDALE, IL 62901-5326
(618) 457-3318
(618) 549-0132
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251V00000X
Voluntary or Charitable Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
08/22/2019
Last updated
08/22/2019
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