| NPI | 1114142049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE M DODSON Vice President 618-327-9846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: IL 01S002) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |