Organization
SUPPORTING COMMUNITY INDEPENDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH ANN SAHURI QIDP,RN (CEO)
(618) 806-4344
Entity
Organization
Contact information
Practice address
1 POLO GROUNDS CT, BETHALTO, IL 62010-2623
(618) 806-4344
Mailing address
1 POLO GROUNDS CT, BETHALTO, IL 62010-2623
(618) 806-4344
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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