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Individual

MR. DEMINGO COLLINS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
613 LAURELWOOD CT, O FALLON, IL 62269-7064
(702) 875-1766
Mailing address
613 LAURELWOOD CT, O FALLON, IL 62269-7064
(702) 875-1766

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
202400006C
IL

Other

Enumeration date
03/04/2024
Last updated
03/04/2024
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