| NPI | 1629629357 |
|---|---|
| Doing Business As | SHAWNEE HEALTH CARE, CARBONDALE SUD |
| Entity Type | Organization |
| Authorized Contact | PATSY R JENSEN CEO 618-956-9508 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |