| NPI | 1215302583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUDY L BAXTER Executive Director 618-236-2181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: IL 199100111S) |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2015-12-11 |