Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Parent organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Other names
Survivor Recovery Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official
IRIS WESLEY (CEO)
(217) 757-8137
Entity
Organization
Contact information
Practice address
401 N WALNUT ST, SPRINGFIELD, IL 62702-5033
(217) 545-7815
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
(217) 545-2101
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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