NPI 1356890453

Dhs

Organisation Physical Disabilities Residential Treatment Facility Fairfield, IL

Practice location

Address: 109 W Wilson St, Fairfield, IL 62837-1816
Phone: (618) 516-2920

Authorised official

Name: Jennifer Weedman
Title: Cna
Phone: (618) 516-2920

Registered specialties

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 376K00000X (IL)

Other Residential Treatment Facility, Physical Disabilities providers in Illinois →

Registry record

NPI: 1356890453
Entity type: Organization
NPI issued: 30 Sep 2016
Record last updated: 30 Sep 2016

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.