| NPI | 1386708568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE L VACA Administrator 217-222-8641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: IL 44107) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: IL 0044107) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2010-07-15 |