Organization
BELLEVILLE AREA SPC SRV CO - ADM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY J ALLISON (BUSINESS MANAGER)
(618) 355-4700
Entity
Organization
Contact information
Practice address
2411 PATHWAYS CROSSING, BELLEVILLE, IL 62221
(618) 355-4700
(618) 355-4758
Mailing address
2411 PATHWAYS CROSSING, BELLEVILLE, IL 62221
(618) 355-4700
(618) 355-4758
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376004522001
—
IL
Enumeration date
04/27/2007
Last updated
08/22/2020
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