NPI 1003593179

Human Support Services

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Waterloo, IL

Practice location

Address: 224 N Main St Rear, Waterloo, IL 62298-1264
Phone: (618) 939-4444
Mailing address: PO Box 146, Waterloo, IL 62298-0146

Authorised official

Name: Anne Riley
Title: Presdient & Ceo
Phone: (618) 939-4444

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X

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Registry record

NPI: 1003593179
Entity type: Organization
NPI issued: 30 Jun 2023
Record last updated: 30 Jun 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.