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Organization

CHARLESTON TRANSITIONAL FACILITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DENNIS CARPENTER (CFO)
(217) 352-7158
Entity
Organization

Contact information

Practice address
1902 FOX DR., SUITE B, CHAMPAIGN, IL 61820-7158
(217) 352-7158
(217) 252-7166
Mailing address
1902 FOX DR., SUITE B, CHAMPAIGN, IL 61820-7158
(217) 352-7158
(217) 252-7166

Taxonomy

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

Other

Enumeration date
10/03/2006
Last updated
04/14/2021
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