Basic Information
| Provider Information | |||||||||
| NPI: | 1144508920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SINNISSIPPI CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 IL ROUTE 2 | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610219118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152846611 | ||||||||
| FaxNumber: | 8152842834 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 FAIRVIEW DR | ||||||||
| Address2: | |||||||||
| City: | ROCHELLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610682310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155619003 | ||||||||
| FaxNumber: | 8155626692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2011 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | GOOD | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8152846611 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.