NPI 1104958966

Unit 4464 Cypress Hall Upper

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

Practice location

Address: 1000 N Main St, Anna, IL 62906-1652
Phone: (618) 833-5161

Authorised official

Name: Bruce Brown
Title: Reimbursement Officer II
Phone: (618) 833-5161

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X

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

Registry record

NPI: 1104958966
Entity type: Organization
NPI issued: 9 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.