Organization
PARENTS AND FRIENDS OF SLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRYSTAL GRUENENFELDER (ADMINISTRATOR)
(618) 277-7730
Entity
Organization
Contact information
Practice address
1450 CASEYVILLE AVE, SWANSEA, IL 62226-4517
(618) 277-7730
(618) 277-5423
Mailing address
1450 CASEYVILLE AVE, SWANSEA, IL 62226-4517
(618) 277-7730
(618) 277-5423
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
1725481
IL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/28/2007
Last updated
08/01/2016
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