ILLINOIS MEDICAID-SUBSTANCE ABUSE MONMOUTH (NPI# 1427425248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427425248 |
| Entity Type | Organization |
| Organization Name | ILLINOIS MEDICAID-SUBSTANCE ABUSE MONMOUTH |
| Practice Address |
301 Industrial Park Rd Monmouth IL 61462-9794 |
| Practice Telephone | 3097349461 |
| Mailing Telephone | 3097349461 |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2019-08-19 |
| Authorized Official Name | MR. BILL A NELSON (CEO) |
| Authorized Official Telephone | 3093444200 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | Y |
| Parent Organization Name | BRIDGEWAY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
A-0118-0011-A | IL | Behavioral Health & Social Service Providers |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
IL | Allopathic & Osteopathic Physicians | |
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
IL | Allopathic & Osteopathic Physicians | |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
IL | Ambulatory Health Care Facilities | |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
IL | Ambulatory Health Care Facilities |
| Street Address |
301 INDUSTRIAL PARK RD |
| City | MONMOUTH |
| State | IL |
| Zip Code | 61462-9794 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043366495 | Lenna Beth Burnett | Counselor | 301 Industrial Park Rd, Monmouth, IL 61462-9794 | 2007-01-26 |
| 1558516575 | Ruth L Dennis | Registered Nurse | 301 Industrial Park Rd, Monmouth, IL 61462-9794 | 2008-11-18 |
| 1316160823 | Bridgeway Inc | Psychiatry & Neurology | 301 Industrial Park Rd, Monmouth, IL 61462-9794 | 2007-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740806942 | Michelle N Smith | Registered Nurse | 1220 E. 2nd Avenue, Monmouth, IL 61462 | 2020-06-23 |
| 1518413103 | Daniel Chard | Emergency Medical Technician, Basic | 331 S. 6th St, Monmouth, IL 61462 | 2016-09-01 |
| 1174079388 | Patrick Spears | Emergency Medical Technician, Paramedic | 601 Industrial Park Road, Monmouth, IL 61462 | 2016-08-28 |
| 1326222993 | Terri Lynn Gittings | Registered Nurse | Industrial Park Road, Bridgeway Inc, Monmouth, IL 61462 | 2007-12-19 |
| 1811011422 | Hancock Mcdonough Roe 21 | Local Education Agency (LEA) | 1301 N Main, Ste 3, Monmouth, IL 61462 | 2007-03-19 |
| 1295870137 | Warren Achievement Center Inc | Case Management | 1220 East Second Avenue, Monmouth, IL 61462 | 2007-02-20 |
| 1265432363 | Community Medical Center of Western Il Inc | Home Health | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2005-07-29 |
| 1285253997 | Catherine Jane Steck | Physical Therapist | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2020-04-13 |
| 1205482254 | Tonya Renee Gibbs | Nurse Practitioner | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2019-08-15 |
| 1285193441 | Carrie Anne Green | Nurse Practitioner | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2019-03-18 |
| Find all providers in zip 61462 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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|---|---|---|---|---|
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| 1164036661 | Existential Counselor Societ Ltd. | Clinic/Center | 1225 Richards St, Joliet, IL 60433-2745 | 2020-09-02 |
| 1457964934 | Rosecrance Inc | Clinic/Center | 15 N Galena Ave, Freeport, IL 61032-4348 | 2020-08-25 |
| 1922617133 | Recovery Concepts Urbana, LLC | Clinic/Center | 710 W. Killarney St., Urbana, IL 61801 | 2020-07-24 |
| 1174148167 | Associates In Behavioral Health Care | Clinic/Center | 910 Lake St Ste 102, Roselle, IL 60172-3384 | 2020-06-15 |
| 1538784533 | Associates In Behavioral Health Care | Clinic/Center | 1375 E Schaumburg Rd Ste 120, Schaumburg, IL 60194-3643 | 2020-06-15 |
| 1265056964 | Gateway Foundation, Inc. | Clinic/Center | 3040 Finley Rd, Downers Grove, IL 60515-5713 | 2020-05-29 |
| 1922634021 | Lutheran Social Services of Illinois | Clinic/Center | 400 N Cherry St, Morrison, IL 61270-2605 | 2020-03-20 |
| 1144852260 | Vincent Wallace | Clinic/Center | 226 W Ontario St, Chicago, IL 60654-3619 | 2020-02-06 |
| 1093354037 | A Bridge Back, Inc. | Clinic/Center | 314 Mchenry Rd, Buffalo Grove, IL 60089-2428 | 2019-12-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.