Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
SIHF MADISON RECOVERY FACILITY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (COO)
(618) 332-0694
Entity
Organization
Contact information
Practice address
648 STATE ST, MADISON, IL 62060-1420
(618) 397-3303
(618) 397-7802
Mailing address
8080 STATE ST, EAST SAINT LOUIS, IL 62203-1808
(618) 397-3303
(618) 397-7802
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/29/2007
Last updated
10/29/2007
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