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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