Organization
SOUTHERN ILLINOIS COMMUNITY SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BRAVE (CFO)
61858820066
Entity
Organization
Contact information
Practice address
300 E ILLINOIS ST, NEW BADEN, IL 62265-1822
(618) 588-7136
(618) 588-4673
Mailing address
300 E ILLINOIS ST, PO BOX 19, NEW BADEN, IL 62265-1822
(618) 588-7136
(618) 588-4673
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/26/2015
Last updated
08/26/2015
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