Organization
LAVENDER RIDGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KEESHA WOOD-SMITH (REGIONAL DIRECTOR)
(217) 342-4150
Entity
Organization
Contact information
Practice address
1103 N MAPLE ST, EFFINGHAM, IL 62401-1793
(217) 342-4150
(217) 342-4199
Mailing address
1103 N MAPLE ST, EFFINGHAM, IL 62401-1793
(217) 342-4150
(217) 342-4199
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
IL
Other
Enumeration date
09/24/2013
Last updated
09/24/2013
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