| NPI | 1851359871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BYRON WITT Administrator 618-283-1434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: IL 1687983) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-08-22 |