MOULTRIE COUNTY MENTAL HEALTH CENTER - NPI 1811025240 - Community/Behavioral Health in Sullivan, IL

Q: What is the provider's specialty?

The provider's specialty is Community/Behavioral Health with taxonomy code 251S00000X.

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About Moultrie County Mental Health Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOULTRIE COUNTY MENTAL HEALTH CENTER (NPI 1811025240) is a healthcare organization registered as a community/behavioral health in Sullivan, Illinois and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through March 25, 2027 and lists David L. Cole, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1811025240

Entity TypeOrganization

Primary Taxonomy251S00000X

Legal Business NameMOULTRIE COUNTY MENTAL HEALTH CENTER

Location Address12 W HARRISON STSullivan, IL 61951-1907

Mailing Address12 W Harrison StSullivan, IL 61951-1907 · (217) 728-4358 · Fax (217) 728-2270

Phone(217) 728-4358

Fax(217) 728-2270

Organization SubpartNo

Authorized OfficialDavid L. ColeExecutive Director · (217) 728-4358

Enumeration DateFebruary 28, 2007

Last NPPES UpdateJuly 25, 2016

✔ NPI 1811025240 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyCommunity/Behavioral HealthAgencies

Taxonomy Code251S00000X

License✔ Licensed in IL · 04105

Definition

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License A-0043-0002-A (IL)

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 04105 (IL)

Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 180.005810 (IL), 178.004724 (IL), 180.003537 (IL)

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X · License 149.011051 (IL)

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X · License 36052881 (IL)

12 W HARRISON ST, Sullivan, IL 61951

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Other Identifiers 1

Medicare ID-Type Unspecified0360458IL · For Rohi Patil, Md

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 14D2164020
Facility Type: Other - COUNTY
Certificate Effective Date: March 26, 2025
Certificate Expiration Date: March 25, 2027
Laboratory Director: JODI R. TRUSSELL
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Moultrie County Mental Health Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.