| NPI | 1285860452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE TEBBE Vice President 618-465-0044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: IL 94S229) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: IL 94S229) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2009-06-02 |