Southern Illinois Community Support Services

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SOUTHERN ILLINOIS COMMUNITY SUPPORT SERVICES

Practice address

300 E Illinois St
New Baden, IL 62265-1822

Phone

(618) 588-7136

Fax

(618) 588-4673

NPI assigned

Aug 26, 2015

Last updated

Aug 26, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Brave

Title

Cfo

Phone

61858820066

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1440547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1184091167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E ILLINOIS ST",
            "address_2": "PO BOX 19",
            "city": "NEW BADEN",
            "state": "IL",
            "postal_code": "622651822",
            "telephone_number": "618-588-7136",
            "fax_number": "618-588-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E ILLINOIS ST",
            "city": "NEW BADEN",
            "state": "IL",
            "postal_code": "622651822",
            "telephone_number": "618-588-7136",
            "fax_number": "618-588-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS COMMUNITY SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-26",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "BRAVE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "61858820066"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela J Rout, DC
• Royal Living Center
• Royal Living Center Inc
• Lynn Kelly Ryder, LCPC
• Jennifer Sipula, PT
• Southern Illinois Living Centers Inc. (Clinton Manor Living Center)
• Southern Illinois Living Centers Inc. (Clitnon Manor Living Center)
• Jessa Kate Springer
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde (Clinton County Rural Health New Baden)
• Robert Stephens

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Baden, IL
• Providers in New Baden, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; 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.