| St. Charles | |
|
1750 E Main St Suite 40 St Charles IL 60174-2363 | |
| (630) 513-6277 | |
| Not Available |
| Full Name | St. Charles |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1750 E Main St, St Charles, Illinois |
| Authorized Official Name and Position | Elizabeth Hopkins (CQIR MEDICAID COORDINATOR) |
| Authorized Official Contact | 8472456556 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Charles 1750 E Main St Suite 40 St Charles IL 60174-2363 Ph: (630) 513-6277 | St. Charles 1750 E Main St Suite 40 St Charles IL 60174-2363 Ph: (630) 513-6277 |
| NPI Number | 1063748127 |
|---|---|
| Provider Enumeration Date | 10/26/2009 |
| Last Update Date | 09/28/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063748127 | NPI | - | NPPES |
| 2A00-IPI-004 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 253J00000X | Foster Care Agency | 37069157003 (Illinois) | Secondary |
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