Organization
ELM CITY REHABILITATION CENTER, INC.
Active
Other names
Elm City Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS R. FREDERICK (PRESIDENT/CEO)
(217) 245-9504
Entity
Organization
Contact information
Practice address
1314 W WALNUT ST, JACKSONVILLE, IL 62650-1148
(217) 245-9504
(217) 245-2350
Mailing address
1314 W WALNUT ST, JACKSONVILLE, IL 62650-1148
(217) 245-9504
(217) 245-2350
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
0517
IL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
201200001S
IL
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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