NPIMap

Organization Active NPI

Locust Street Resource Center Cila #1

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Carlinville, IL
National Provider Identifier
1700330545
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
LOCUST STREET RESOURCE CENTER CILA #1
Practice address
124 W Buchanan St
Carlinville, IL 62626-1027
Phone
(217) 854-3166
Fax
(217) 854-9729
NPI assigned
Aug 10, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LOCUST STREET RESOURCE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Tracy Haynes
Title
Manager
Phone
(217) 854-3166

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X IL
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

124 W Buchanan St
Carlinville, IL 62626-1027

Mailing address

320 S Locust St
Carlinville, IL 62626-1648
Phone (217) 854-3166

Other names 1

  • MACOUPIN COUNTY MENTAL HEALTH Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Locust Street Resource Center Cila 29 organizations share this tax ID, including this one
Part of
Locust Street Resource Center Cila 2

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1700330545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S LOCUST ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261648",
            "telephone_number": "217-854-3166",
            "fax_number": "217-854-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W BUCHANAN ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261027",
            "telephone_number": "217-854-3166",
            "fax_number": "217-854-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCUST STREET RESOURCE CENTER CILA #1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOCUST STREET RESOURCE CENTER",
        "enumeration_date": "2016-08-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-854-3166",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MACOUPIN COUNTY MENTAL HEALTH",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "MACOUPIN COUNTY MENTAL HEALTH",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Carlinville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.