Organization
SOUTHERN ILLINOIS TREATMENT CENTER, LLC
Active
Organization
SOUTHERN ILLINOIS TREATMENT CENTER, LLC
Active
Other names
MedMark Treatment Centers Wood River
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE JARVIE (VP, TREASURER)
(214) 379-3300
Entity
Organization
Contact information
Practice address
304 WESLEY DR STE 302306, WOOD RIVER, IL 62095-2266
(618) 258-7592
Mailing address
1720 LAKEPOINTE DR STE 117, LEWISVILLE, TX 75057-6425
(214) 379-3300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
07/29/2024
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