OrganizationActive
Intensive Out-Patient Care
NPI 1255715280 · Community/Behavioral Health Agency · Edwardsville, IL
Provider details
- NPI number
- 1255715280
- Entity type
- Organization
- Primary specialty
- Community/Behavioral Health AgencyAgencies
- Organization subpart
- No
- Authorized official
- Jennifer Manning, Director(618) 656-7064
- License
- 371259842 (IL)
Specialties & taxonomies
Agencies
Profile Score
Established profile(73/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2 Club Centre Ct
Suite 1
Edwardsville, IL 62025-3503
Phone: (618) 656-7064
Fax: (618) 656-9084
Approximate (ZIP-level) locationGet directions
Mailing address
2 Club Centre Ct
Edwardsville, IL 62025-3503
Registry dates
- Enumerated
- 2015-07-20
- Last updated
- 2015-07-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.