| NPI | 1124619697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DAVID CHURCH Vice President Of Finance 618-972-5228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| 225XG0600X Occupational Therapist, Gerontology | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2023-12-16 |