Organization
CUBBULL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN L BARNHART RN, MS, MAED, QIDP (PRESIDENT)
(309) 224-4093
Entity
Organization
Contact information
Practice address
121 W ELM ST, BOX 478, CANTON, IL 61520-2513
(309) 224-4093
Mailing address
121 W ELM ST, BOX 478, CANTON, IL 61520-2513
(309) 224-4093
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
200900009S
IL
Other
Enumeration date
05/02/2016
Last updated
05/02/2016
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