Organization
LEBANON TERRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA L JONES (QMRP)
(618) 537-4133
Entity
Organization
Contact information
Practice address
221 E 3RD ST, LEBANON, IL 62254-1668
(618) 537-4133
(618) 537-4156
Mailing address
221 E 3RD ST, LEBANON, IL 62254-1668
(618) 537-4133
(618) 537-4156
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
0038430
IL
Other
Enumeration date
03/28/2007
Last updated
08/22/2020
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