NPI 1104071125
West Lake Residential - Building 220
Practice location
- Address
- 200 W Lake Dr Building 220, Springfield, IL 62703-4956
- Phone
- (217) 588-7934
- Fax
- (217) 529-9803
- Mailing address
- 200 W Lake Dr Bldg 220, Springfield, IL 62703-4956
Authorised official
- Name
- Ann Bowling
- Title
- Director
- Phone
- (217) 588-2626
Registered specialties
Mental Illness Community Based Residential Treatment Facility
Primary
Registry record
- NPI
- 1104071125
- Entity type
- Organization
- NPI issued
- 18 Nov 2008
- Record last updated
- 31 Oct 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.