# DHS

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

## Provider details

- **NPI number:** 1356890453
- **Authorized official:** JENNIFER WEEDMAN (CNA)
- **Authorized official phone:** (618) 516-2920

## Contact information

- **Practice address:** 109 W WILSON ST, FAIRFIELD, IL 62837-1816
- **Practice address phone:** (618) 516-2920
- **Mailing address:** 109 W WILSON ST, FAIRFIELD, IL 62837-1816
- **Mailing address phone:** (618) 516-2920

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 376K00000X | IL | Yes |

## Other

- **Enumeration date:** 09/30/2016
- **Last updated:** 09/30/2016