NPI 1164646550

Mulberry Manor, INC.

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

Practice location

Address: 612 E Davie, Anna, IL 62906-0088
Phone: (618) 833-6012
Mailing address: PO Box 88, Anna, IL 62906-0088

Authorised official

Name: Joann Keller
Title: Administrator
Phone: (618) 833-6012

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X

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Registry record

NPI: 1164646550
Entity type: Organization
NPI issued: 13 Apr 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.