Organization
SHELBY COUNTY COMMUNITY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS COLCLASURE (EXECUTIVE DIRECTOR)
(217) 774-5587
Entity
Organization
Contact information
Practice address
1810 W SOUTH 3RD ST, SHELBYVILLE, IL 62565-9595
(217) 774-5587
Mailing address
1810 W SOUTH 3RD ST, SHELBYVILLE, IL 62565-9595
(217) 774-5587
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
04121
IL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
199100020S
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04121
—
IL
Enumeration date
01/06/2016
Last updated
01/06/2016
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