Organization
GLEN BROOK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES KELLER (ADMINISTRATOR)
(618) 833-5070
Entity
Organization
Contact information
Practice address
801 NORTH 1ST STREET, VIENNA, IL 62995-1544
(618) 658-2005
Mailing address
801 NORTH 1ST STREET, VIENNA, IL 62995-1544
(618) 658-2005
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
IL
Other
Enumeration date
04/13/2007
Last updated
08/22/2020
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