Organization
COMWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BAUER (IT COORDINATOR)
(618) 282-6233
Entity
Organization
Contact information
Practice address
10257 STATE ROUTE 3, RED BUD, IL 62278-4418
(618) 282-6233
(618) 282-6949
Mailing address
10257 STATE ROUTE 3 BLDG A, RED BUD, IL 62278-4418
(618) 282-6233
(618) 282-6949
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51013833018
ILLINOIS PROVIDER NUMBER
IL
Enumeration date
01/16/2009
Last updated
02/04/2021
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