Organization
MARYS VILLAGE FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHANTA DOSS MS (OWNER)
(618) 974-4807
Entity
Organization
Contact information
Practice address
3922 N BELT W, BELLEVILLE, IL 62226-5608
(618) 974-4807
Mailing address
3922 N BELT W, BELLEVILLE, IL 62226-5608
(618) 974-4807
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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