Organization
LEWIS MEMORIAL CHRISTIAN VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HENSEY (PTA)
(217) 787-9600
Entity
Organization
Contact information
Practice address
3400 W WASHINGTON ST, SPRINGFIELD, IL 62711-7917
(217) 787-9600
Mailing address
3400 W WASHINGTON ST, SPRINGFIELD, IL 62711-7917
(217) 787-9600
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
160003483
IL
Other
Enumeration date
09/13/2010
Last updated
09/13/2010
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