NPI 1023643772
Supporting Community Independence
Practice location
- Address
- 1 Polo Grounds CT, Bethalto, IL 62010-2623
- Phone
- (618) 806-4344
Authorised official
- Name
- Elizabeth Ann Sahuri
- Title
- Ceo
- Phone
- (618) 806-4344
Registered specialties
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
Registry record
- NPI
- 1023643772
- Entity type
- Organization
- NPI issued
- 3 Mar 2020
- Record last updated
- 3 Mar 2020
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.