Organization
CEREBRAL PALSY OF SOUTHWESTERN ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE HAEGE (EXECUTIVE DIRECTOR)
(618) 233-0210
Entity
Organization
Contact information
Practice address
138 LINCOLN PLACE CT, SUITE 101, BELLEVILLE, IL 62221-5884
(618) 233-0210
Mailing address
138 LINCOLN PLACE CT, SUITE 101, BELLEVILLE, IL 62221-5884
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
199100130S
IL
Other
Enumeration date
09/14/2015
Last updated
10/06/2015
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