Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
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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