Organization
BEVERLY FARM FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA MILLER (FINANCE DIRECTOR)
(618) 466-0367
Entity
Organization
Contact information
Practice address
224 BACHMAN LN, GODFREY, IL 62035-2122
(618) 466-0367
(618) 466-3652
Mailing address
6301 HUMBERT RD, GODFREY, IL 62035-2163
(618) 466-0367
(618) 466-3652
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0036939
IL
Other
Enumeration date
11/21/2006
Last updated
08/25/2016
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