Organization
CARDINAL HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY MICHAEL BLAKELY PT QMRP (EX DIR SE)
(618) 833-7756
Entity
Organization
Contact information
Practice address
200 DOUGLAS STREET, ANNA, IL 62906
(618) 833-7756
(618) 833-7756
Mailing address
PO BOX 622, ANNA, IL 62906-0622
(618) 833-7756
(618) 833-7806
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
965010
IL
Other
Enumeration date
02/06/2008
Last updated
02/06/2008
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