Provider Demographics
NPI:1730871575
Name:JEFFERSON COUNTY COMPREHENSIVE SVC INC
Entity type:Organization
Organization Name:JEFFERSON COUNTY COMPREHENSIVE SVC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE SERVICES SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-242-1510
Mailing Address - Street 1:16338 N IL HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-8178
Mailing Address - Country:US
Mailing Address - Phone:618-242-1510
Mailing Address - Fax:
Practice Address - Street 1:1706 S 13TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-4932
Practice Address - Country:US
Practice Address - Phone:618-242-1610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)