Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Other names
LifeLinks Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CEO)
(618) 332-0694
Entity
Organization
Contact information
Practice address
750 BROADWAY AVE E, MATTOON, IL 61938-4610
(217) 238-5700
Mailing address
2041 GOOSE LAKE RD, SAUGET, IL 62206-2822
(618) 332-0953
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
H80CS00195
IL
Other
Enumeration date
10/20/2016
Last updated
10/20/2016
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