Southeastern Il Agency on Aging, Inc

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

SOUTHEASTERN IL AGENCY ON AGING, INC

Practice address

516 N Market St
Mount Carmel, IL 62863-1558

Phone

(618) 262-2306

Fax

(618) 262-4967

NPI assigned

Sep 15, 2015

Last updated

Sep 15, 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

Shana A Holmes, BS,BA

Title

Executive Director

Phone

(618) 262-2306

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1508235060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 N MARKET ST",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "628631558",
            "telephone_number": "618-262-2306",
            "fax_number": "618-262-4967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 N MARKET ST",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "628631558",
            "telephone_number": "618-262-2306",
            "fax_number": "618-262-4967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN IL AGENCY ON AGING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "SHANA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-262-2306",
        "authorized_official_credential": "BS,BA"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rachel A Stephens, ATC, LAT

• Voluntary or Charitable Agency in Mount Carmel, IL
• Providers in Mount Carmel, IL by specialty
• Voluntary or Charitable Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.