NPI 1104945716

Lebanon Terrace

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Lebanon, IL

Practice location

Address: 221 E 3rd St, Lebanon, IL 62254-1668
Phone: (618) 537-4133
Fax: (618) 537-4156

Authorised official

Name: Donna L Jones
Title: Qmrp
Phone: (618) 537-4133

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 0038430 (IL)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Illinois →

Registry record

NPI: 1104945716
Entity type: Organization
NPI issued: 28 Mar 2007
Record last updated: 22 Aug 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.