Organization
PASSAVANT MEMORIAL AREA HOSPITAL
Active
Other names
THE CENTER FOR PSYCHIATRIC HEALTH
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY RAGEL (CFO/VICE PRESIDENT OF FINANCE)
(217) 479-5527
Entity
Organization
Contact information
Practice address
557 N WESTGATE AVE, JACKSONVILLE, IL 62650-1156
(217) 245-7275
(217) 245-7427
Mailing address
PO BOX 1977, SPRINGFIELD, IL 62705-1977
(217) 544-6464
(217) 757-6021
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06932018
BLUE CROSS BLUE SHIELD
IL
01
—
681484
HEALTHLINK PROVIDER #
IL
01
—
CB3741
RAILROAD MEDICARE
IL
Enumeration date
06/08/2006
Last updated
08/23/2007
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