Organization
SOUTHERN ILLINOIS CASE COORDINATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ROGER HAKE (EXECUTIVE DIRECTOR)
(618) 532-4300
Entity
Organization
Contact information
Practice address
519 S LOCUST ST # 588, CENTRALIA, IL 62801-4223
(618) 532-4300
(618) 532-9416
Mailing address
519 S LOCUST ST # 588, CENTRALIA, IL 62801-4223
(618) 532-4300
(618) 532-9416
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
40CM001645
IL
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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