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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