| NPI | 1790136414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ENGELHARDT Executive Director 618-542-5421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: IL 199100056S) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2016-06-23 |