JEFFERSON COUNTY COMPREHENSIVE (NPI# 1649404708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649404708 |
| Entity Type | Organization |
| Organization Name | JEFFERSON COUNTY COMPREHENSIVE |
| Other Organization Name | SUBSTANCE ABUSE OUTPATIENT |
| Practice Address |
16338 N Il Hwy 37 Mt Vernon IL 62864 |
| Mailing Address |
Po Box 428 Mount Vernon IL 62864-0054 |
| Practice Telephone | 6182421994 |
| Practice Fax Number | 6182426392 |
| Mailing Telephone | 6182421994 |
| Mailing Fax Number | 6182426392 |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2018-08-17 |
| Authorized Official Name | MR. DANIEL P BOEHMER (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6182421994 |
| Authorized Official Credential | MA, LCPC, QMHP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | 002250003 | IL | Agencies |
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 002250003 | IL | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Substance Abuse Outpatient | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972533990 | Jefferson County Comprehensive | Clinic/Center | 16342 N Il Hwy 37, Mt Vernon, IL 62864 | 2006-07-04 |
| Street Address |
16338 N IL HWY 37 |
| City | MT VERNON |
| State | IL |
| Zip Code | 62864 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710200993 | Amy Correll | Case Manager/Care Coordinator | 16338 N Il Hwy 37, Mt Vernon, IL 62864 | 2010-03-02 |
| 1982937710 | Phyllis Howard | Counselor | 16338 N Il Hwy 37, Mt Vernon, IL 62864 | 2009-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548860729 | New Gen Ed Inc. | Substance Abuse Rehabilitation Facility | 1219 N Gary Ave, Carol Stream, IL 60188-9028 | 2020-10-28 |
| 1578187886 | Silver Glen Road Opco LLC | Substance Abuse Rehabilitation Facility | 41w400 Silver Glen Rd, St Charles, IL 60175-8453 | 2020-06-02 |
| 1669025672 | Gateway Foundation, Inc. | Substance Abuse Rehabilitation Facility | 25480 W Cedar Crest Ln Bldg A, Lake Villa, IL 60046-9744 | 2019-07-18 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1033673165 | Michael David Lauts | Substance Abuse Rehabilitation Facility | 215 E 25th St Apt 228, Sterling, IL 61081-1092 | 2019-01-23 |
| 1457829632 | Hope Behavioral Services At The Jeannine Brent Center Incorporated | Substance Abuse Rehabilitation Facility | 2319 Plainfield Rd, Crest Hill, IL 60403-1875 | 2018-11-06 |
| 1063989143 | Northwest Recovery Center LLC | Substance Abuse Rehabilitation Facility | 5352 N Lincoln Ave Ste 250, Chicago, IL 60625-2316 | 2018-10-26 |
| 1982182671 | Rosecrance, Inc. | Substance Abuse Rehabilitation Facility | 2835 N Sheffield Ave Ste 209, Chicago, IL 60657-5083 | 2018-08-03 |
| 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.