SHELBY COUNTY COMMUNITY SERVICES INC NPI 1801252994

NPI Information

NPI: 1801252994
Provider Name: SHELBY COUNTY COMMUNITY SERVICES INC
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization

CLIA Number: 14D2210901

Address:
1810 W SOUTH 3RD ST
SHELBYVILLE, IL
ZIP 62565
Phone: (217) 774-5587
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SHELBY COUNTY COMMUNITY SERVICES INC is a community based residential treatment facility, intellectual and/or developmental disabilities in Shelbyville, IL. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. SHELBY COUNTY COMMUNITY SERVICES INC NPI is 1801252994. The provider is registered as an organization entity type.

The provider's business location address is:

1810 W SOUTH 3RD ST
SHELBYVILLE, IL
ZIP 62565-595
Phone: (217) 774-5587

The provider's authorized official is Thomas Colclasure .
The authorized official title is Executive Director and has the following contact phone number (217) 774-5587.

The CLIA number assigned to this NPI record is 14D2210901 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/6/2016 and was last updated on 1/6/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	251B00000X	Case Management			No
2	251C00000X	Day Training, Developmentally Disabled Services			No
3	320800000X	Community Based Residential Treatment Facility, Mental Illness	04121	ILLINOIS	No
4	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	199100020S	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	04121	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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