# EPILEPSY FOUNDATION OF GREATER SOUTHERN ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215302583
- **Authorized official:** TRUDY L BAXTER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (618) 236-2181

## Contact information

- **Practice address:** 3515 N BELT W, BELLEVILLE, IL 62226-5944
- **Practice address phone:** (618) 236-2181
- **Practice address fax:** (618) 236-3654
- **Mailing address:** 3515 N BELT W, BELLEVILLE, IL 62226-5944
- **Mailing address phone:** (618) 236-2181
- **Mailing address fax:** (618) 236-3654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 199100111S | IL | Yes |

## Other

- **Enumeration date:** 12/11/2015
- **Last updated:** 12/11/2015