Organization
SUPPORT SYSTEMS AND SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JAQUES (PRESIDENT/CEO)
(618) 277-4100
Entity
Organization
Contact information
Practice address
900 ROYAL HEIGHTS RD, BELLEVILLE, IL 62226-5457
(618) 277-4100
(618) 277-4355
Mailing address
900 ROYAL HEIGHTS RD, BELLEVILLE, IL 62226-5457
(618) 277-4100
(618) 277-4355
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/17/2009
Last updated
10/07/2015
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