Organization
COMWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBER L BROWNE (DIRECTOR OF FINANCE)
(618) 282-6233
Entity
Organization
Contact information
Practice address
104 NORTHTOWN RD, SPARTA, IL 62286
(618) 443-3045
(618) 443-5767
Mailing address
104 NORTHTOWN RD, SPARTA, IL 62286-1081
(618) 443-3045
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-0280-0002-A
IL
Other
Enumeration date
05/08/2007
Last updated
02/04/2021
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