Organization
FIVE STAR INDUSTRIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN ENGELHARDT (EXECUTIVE DIRECTOR)
(618) 542-5421
Entity
Organization
Contact information
Practice address
1308 WELLS STREET RD, DU QUOIN, IL 62832-4171
(618) 542-5421
(618) 790-9147
Mailing address
PO BOX 60, DU QUOIN, IL 62832-0060
(618) 542-5421
(618) 790-9147
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
IL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
199100056S
IL
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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