Organization
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Active
Parent organization
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Other names
Shawnee Health Care, Carbondale
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Authorized official
CHRISTINA CARNEY (CEO)
(618) 956-9521
Entity
Organization
Contact information
Practice address
400 S LEWIS LN, CARBONDALE, IL 62901-3547
(618) 519-9900
(618) 519-9961
Mailing address
109 CALIFORNIA ST, PO BOX 577, CARTERVILLE, IL 62918-1923
(618) 985-8221
(618) 985-6860
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CF3444
MEDICARE RR
IL
Enumeration date
08/20/2009
Last updated
07/17/2024
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