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Organization
HOME AND ENVIRONMENTS FOR LIVING AND PROGRAMS
Active
Organization
HOME AND ENVIRONMENTS FOR LIVING AND PROGRAMS
Active
Other names
Lebanon Terrace
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHERINE A BROOKSHIRE (ADMINISTRATOR)
(217) 529-9632
Entity
Organization
Contact information
Practice address
221 E 3RD ST, LEBANON, IL 62254-1668
(618) 537-4133
(618) 537-4156
Mailing address
40 ADLOFF LN STE 5, SPRINGFIELD, IL 62703-4496
(217) 529-9632
(217) 529-9635
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0038430
IL
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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