Organization
COMWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY RENNER AM (BILLING/CREDENTIALING)
(618) 282-6233
Entity
Organization
Contact information
Practice address
207 N JAMES ST, SPARTA, IL 62286-1213
(618) 282-6233
Mailing address
10257 STATE ROUTE 3, RED BUD, IL 62278-4418
(618) 282-6233
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/22/2024
Last updated
08/22/2024
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