Organization
PREVENTIVE DEVELOPMENT DISABILITY AND HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CONSTANCE ETENGENENG NGASSA RN (PRESIDENT - DIRECTOR)
(331) 250-2492
Entity
Organization
Contact information
Practice address
2481 MAYFIELD DR, MONTGOMERY, IL 60538-5057
(331) 250-2492
Mailing address
2481 MAYFIELD DR, MONTGOMERY, IL 60538-5057
(331) 250-2492
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/23/2025
Last updated
07/23/2025
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