Organization
SPENCER TERRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M ROBERTS (PRESIDENT)
(618) 262-8909
Entity
Organization
Contact information
Practice address
137 SOUTH DR, MOUNT CARMEL, IL 62863-2811
(618) 262-8909
Mailing address
137 SOUTH DR, MOUNT CARMEL, IL 62863-2811
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
3701224518001
IL
Other
Enumeration date
06/21/2007
Last updated
08/22/2020
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