NPIMap

Organization Active NPI

Christian Social Services of Illinois

  • Foster Care Agency
  • Mount Vernon, IL
National Provider Identifier
1629328802
Registry record updated Sep 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
License
003976-12 Issued in IL
Legal business name
CHRISTIAN SOCIAL SERVICES OF ILLINOIS
Practice address
219 Withers Dr
Mount Vernon, IL 62864-8273
Phone
(618) 244-0344
Fax
(618) 244-1455
NPI assigned
Sep 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2012

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

Authorized official

Name
Brad G. Beck, MPA
Title
Associate Executive Director
Phone
(618) 688-1161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foster Care Agency 253J00000X 003976-12 IL Primary

Addresses

Primary practice location

219 Withers Dr
Mount Vernon, IL 62864-8273

Mailing address

219 Withers Dr
Mount Vernon, IL 62864-8273
Phone (618) 244-0344

Other identifiers 2

IdentifierTypeStateIssuer
1598031700MedicaidIL
1861758575MedicaidIL

Other names 1

  • Catholic Social Services of Southern IL Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Christian Social Services of Illinois24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347580800000",
    "number": "1629328802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 WITHERS DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628648273",
            "telephone_number": "618-244-0344",
            "fax_number": "618-244-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 WITHERS DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628648273",
            "telephone_number": "618-244-0344",
            "fax_number": "618-244-1455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN SOCIAL SERVICES OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2012-09-14",
        "status": "A",
        "authorized_official_last_name": "BECK",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "ASSOCIATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-688-1161",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "IL",
            "license": "003976-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598031700",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861758575",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Catholic Social Services of Southern IL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; 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.