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Organization

UNIT 4462 CEDAR HALL UPPER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRUXE BROWN (REIMBURSEMENT OFFICER II)
(618) 833-5161
Entity
Organization

Contact information

Practice address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161
Mailing address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
14G045
IL
Enumeration date
03/09/2007
Last updated
08/22/2020
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