Organization
BROTHER JAMES COURT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON WAMPLER (ADMINISTATOR)
(217) 747-5900
Entity
Organization
Contact information
Practice address
2508 SAINT JAMES RD, SPRINGFIELD, IL 62707-9736
(217) 544-4876
(217) 747-5914
Mailing address
2508 SAINT JAMES RD, SPRINGFIELD, IL 62707-9736
(217) 544-4876
(217) 747-5914
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
0020495
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G039
—
IL
Enumeration date
03/14/2007
Last updated
08/22/2020
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