NPI 1548305675

Illinois Department of Human Services

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

Practice location

Address: 1535 W McCord St, Centralia, IL 62801-5805
Phone: (618) 532-1811
Fax: (618) 532-7464

Authorised official

Name: James Veach
Title: Center Director
Phone: (618) 532-1811

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 805-8000 (IL)

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

Registry record

NPI: 1548305675
Entity type: Organization
NPI issued: 20 Feb 2007
Record last updated: 20 Jun 2008

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.