Organization
RACCOON C S D 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN RENCH (DIRECTOR)
(618) 532-4721
Entity
Organization
Contact information
Practice address
3601 STATE RD STE 161, CENTRALIA, IL 62801-0000
(618) 532-4721
Mailing address
3601 STATE RD STE 161, CENTRALIA, IL 62801-0000
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Enumeration date
06/05/2007
Last updated
08/22/2020
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