OrganizationActive
Good Samaritan House of Granite City, Inc
NPI 1134612054 · Adolescent and Children Mental Health Clinic/Center · Granite City, IL
Provider details
- NPI number
- 1134612054
- Entity type
- Organization
- Primary specialty
- Adolescent and Children Mental Health Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Latosha Davis, Executive Director(618) 219-9513
- License
- 149.019998 (IL)
Specialties & taxonomies
Ambulatory Health Care Facilities
- Mental Health Clinic/Center (Including Community Mental Health Center)261QM0801XLicense 149.019998 (IL)
Ambulatory Health Care Facilities
Ambulatory Health Care Facilities
Practice location
1825 Delmar Ave
Granite City, IL 62040-4508
Phone: (618) 876-0607
Approximate (ZIP-level) locationGet directions
Mailing address
1825 Delmar Ave
Granite City, IL 62040-4508
Registry dates
- Enumerated
- 2018-06-14
- Last updated
- 2018-06-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.