Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
Charleston Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY MCCULLEY (CEO)
(618) 332-0694
Entity
Organization
Contact information
Practice address
626 W LINCOLN AVE, CHARLESTON, IL 61920-2444
(217) 345-7702
(217) 345-7705
Mailing address
2041 GOOSE LAKE RD, SAUGET, IL 62206-2822
(618) 332-0953
(618) 332-2487
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
03/10/2014
Last updated
06/02/2016
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