| Macon Resources, Inc. | |
|
2121 Hubbard Ave Decatur IL 62526-2876 | |
| (217) 872-5380 | |
| Not Available |
| Full Name | Macon Resources, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2121 Hubbard Ave, Decatur, Illinois |
| Authorized Official Name and Position | Priscilla Maxwell (DIRECTOR OF BEHAVIORAL HEALTH) |
| Authorized Official Contact | 2178725380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Macon Resources, Inc. 2121 Hubbard Ave Decatur IL 62526-2876 Ph: (217) 872-5380 | Macon Resources, Inc. 2121 Hubbard Ave Decatur IL 62526-2876 Ph: (217) 872-5380 |
| NPI Number | 1457044919 |
|---|---|
| Provider Enumeration Date | 05/31/2023 |
| Last Update Date | 05/31/2023 |
| Certification Date | 05/31/2023 |
| Medicare PECOS PAC ID | 2264430321 |
|---|---|
| Medicare Enrollment ID | O20240118000073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457044919 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Abby Steele |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356122485 PECOS PAC ID: 4082066741 Enrollment ID: I20240118000088 |
| Provider Name | Priscilla Maxwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215623764 PECOS PAC ID: 7719339472 Enrollment ID: I20240202003089 |
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