NPIMap

Organization Active NPI

Shelby County Community Services Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Shelbyville, IL
National Provider Identifier
1801252994
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
199100020S Issued in IL
Legal business name
SHELBY COUNTY COMMUNITY SERVICES INC
Practice address
1810 W South 3Rd St
Shelbyville, IL 62565-9595
Phone
(217) 774-5587
NPI assigned
Jan 6, 2016
Last updated
Jan 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

Name
Thomas Colclasure
Title
Executive Director
Phone
(217) 774-5587

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Developmentally Disabled Services Day Training Agency 251C00000X NU
Mental Illness Community Based Residential Treatment Facility 320800000X 04121 IL
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 199100020S IL Primary

Addresses

Primary practice location

1810 W South 3Rd St
Shelbyville, IL 62565-9595

Mailing address

1810 W South 3Rd St
Shelbyville, IL 62565-9595
Phone (217) 774-5587

Other identifiers 1

IdentifierTypeStateIssuer
04121MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Shelby County Community Services Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1452038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1801252994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 W SOUTH 3RD ST",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625659595",
            "telephone_number": "217-774-5587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 W SOUTH 3RD ST",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625659595",
            "telephone_number": "217-774-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY COUNTY COMMUNITY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-06",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "COLCLASURE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "217-774-5587"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "IL",
            "license": "04121",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "199100020S",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04121",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.