Organization
TRADE INDUSTRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK A AUTEN MBA (VICE PRESIDENT)
(618) 643-4321
Entity
Organization
Contact information
Practice address
ROUTE 14 EAST, MC LEANSBORO, IL 62859-0070
(618) 643-4321
(618) 643-4230
Mailing address
PO BOX 70, MC LEANSBORO, IL 62859-0070
(618) 643-4321
(618) 643-4230
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
IL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
0491
IL
Other
Enumeration date
03/01/2007
Last updated
07/21/2022
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