Organization
WILLOWGLEN ACADEMY-IL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH A KINARD (EXECUTIVE DIRECTOR)
(815) 233-6162
Entity
Organization
Contact information
Practice address
3111 W KUNKLE BLVD, FREEPORT, IL 61032-6922
(815) 233-0406
Mailing address
701 W LAMM RD, FREEPORT, IL 61032-9630
(815) 233-6162
(815) 233-6167
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
411197-03
IL
Other
Enumeration date
06/13/2007
Last updated
08/22/2020
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