| NPI | 1811534167 |
|---|---|
| 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 | 235Z00000X Speech-Language Pathologist, |
| 2251G0304X Physical Therapist, Geriatrics | |
| 225XG0600X Occupational Therapist, Gerontology | |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2021-11-08 |