Organization
GOOD SAMARITAN HOUSE OF GRANITE CITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATOSHA R DAVIS LCSW (EXECUTIVE DIRECTOR)
(618) 219-9513
Entity
Organization
Contact information
Practice address
1825 DELMAR AVE, GRANITE CITY, IL 62040-4508
(618) 876-0607
Mailing address
1825 DELMAR AVE, GRANITE CITY, IL 62040-4508
(618) 876-0607
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
149.019998
IL
261QM0850X
Adult Mental Health Clinic/Center
149.019998
IL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
149.019998
IL
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
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