Organization
PIASA MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL ANN DODD (QMRP)
(618) 466-9242
Entity
Organization
Contact information
Practice address
110 N ALBY CT, GODFREY, IL 62035-1963
(618) 466-9242
(618) 466-9517
Mailing address
110 N ALBY CT, GODFREY, IL 62035-1963
(618) 466-9242
(618) 466-9517
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
0038422
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371272004
—
IL
Enumeration date
03/28/2007
Last updated
08/04/2008
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