Organization
LOCUST STREET RESOURCE CENTER CILA #1
Active
Parent organization
LOCUST STREET RESOURCE CENTER
Other names
MACOUPIN COUNTY MENTAL HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOCUST STREET RESOURCE CENTER
Authorized official
MRS. TRACY HAYNES (MANAGER)
(217) 854-3166
Entity
Organization
Contact information
Practice address
124 W BUCHANAN ST, CARLINVILLE, IL 62626-1027
(217) 854-3166
(217) 854-9729
Mailing address
320 S LOCUST ST, CARLINVILLE, IL 62626-1648
(217) 854-3166
(217) 854-9729
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
IL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/10/2016
Last updated
07/21/2022
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