# DECATUR ATHLETIC CLUB

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

## Provider details

- **NPI number:** 1588892475
- **Authorized official:** ALICE YVONNE DANIELS (DIRECTOR OF POST REHABILITATION)
- **Authorized official phone:** (217) 423-7020

## Contact information

- **Practice address:** 1010 W SOUTH SIDE DR, DECATUR, IL 62521-4023
- **Practice address phone:** (217) 423-7020
- **Practice address fax:** (217) 423-7562
- **Mailing address:** 1010 W SOUTH SIDE DR, DECATUR, IL 62521-4023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/30/2009
- **Last updated:** 06/30/2009