NPIMap

Organization Active NPI

Shawnee Health Service and Development Corp

  • Methadone Clinic
  • Carbondale, IL
National Provider Identifier
1629629357
Registry record updated Sep 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Practice address
400 S Lewis LN
Carbondale, IL 62901-3547
Phone
(618) 519-9200
Fax
(618) 519-9961
NPI assigned
Sep 24, 2019
Organization subpart
Yes
Parent organization
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2019

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

Authorized official

Name
Patsy R Jensen
Title
Ceo
Phone
(618) 956-9508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

400 S Lewis LN
Carbondale, IL 62901-3547

Mailing address

PO Box 577
109 California St
Carterville, IL 62918-0577
Phone (618) 519-9200

Other names 1

  • Shawnee Health Care, Carbondale SUD Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Tower Health Cent36 organizations share this tax ID, including this one
Part of
Grand Tower Health Cent

Other organizations with this tax ID 35

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

View all 35

Locations

400 S Lewis Ln
Carbondale, IL 62901
Phone (618) 519-9900

NPI Registry JSON

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569283200000",
    "number": "1629629357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577",
            "address_2": "109 CALIFORNIA ST",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180577",
            "telephone_number": "618-519-9200",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S LEWIS LN",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013547",
            "telephone_number": "618-519-9200",
            "fax_number": "618-519-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP",
        "enumeration_date": "2019-09-24",
        "last_updated": "2019-09-24",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "PATSY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-956-9508"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shawnee Health Care, Carbondale SUD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; 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.