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Organization
WILLOWGLEN ACADEMY ILLINOIS
Active
Organization
WILLOWGLEN ACADEMY ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA JO CUSIMANO (QIDP)
(815) 233-6162
Entity
Organization
Contact information
Practice address
701 W LAMM RD, FREEPORT, IL 61032-9630
(815) 233-6162
Mailing address
701 W LAMM RD, FREEPORT, IL 61032-9630
(815) 233-6162
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
IL
Other
Enumeration date
10/28/2016
Last updated
10/28/2016
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