NPIMap

Organization Active NPI

Mental Health Centers of Central Illinois

Doing business as Memorial Behavioral Health - Jacksonville

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Jacksonville, IL
National Provider Identifier
1013401322
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Doing business as
Memorial Behavioral Health - Jacksonville
Practice address
340 W State St
Jacksonville, IL 62650-2061
Phone
(217) 245-6126
Fax
(217) 245-4296
NPI assigned
Jun 20, 2018
Last updated
Oct 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MENTAL HEALTH CENTERS OF CENTRAL ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ann Bowling
Title
Director
Phone
(217) 588-2626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

340 W State St
Jacksonville, IL 62650-2061

Mailing address

340 W State St
Jacksonville, IL 62650-2061
Phone (217) 245-6126

Other names 1

  • Memorial Behavioral Health - Jacksonville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
C C S15 organizations share this tax ID, including this one
Part of
C C S

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

340 W State St
Jacksonville, IL 62650
Phone (217) 245-6126

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1013401322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 W STATE ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502061",
            "telephone_number": "217-245-6126",
            "fax_number": "217-245-4296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 W STATE ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502061",
            "telephone_number": "217-245-6126",
            "fax_number": "217-245-4296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS",
        "enumeration_date": "2018-06-20",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "BOWLING",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-588-2626"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Behavioral Health - Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Behavioral Health - Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.