Organization
HAZEL BLAND PROMISE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIVIAN E. THOMPSON (FAMILY SUPPORT UNIT DIRECTOR)
(618) 274-3500
Entity
Organization
Contact information
Practice address
2900 STATE ST, EAST SAINT LOUIS, IL 62205-2234
(618) 274-3500
Mailing address
2900 STATE ST, EAST SAINT LOUIS, IL 62205-2234
(618) 274-3500
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
199200170S
IL
Other
Enumeration date
06/28/2016
Last updated
06/28/2016
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