Organization
GROW IN ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANNE MAXWELL (RESIDENTIAL COORDINATOR)
(815) 933-6690
Entity
Organization
Contact information
Practice address
223 MOHAWK DR, BOURBONNAIS, IL 60914-1351
(815) 933-6690
(815) 933-9937
Mailing address
1108 E COURT ST, KANKAKEE, IL 60901-4257
(815) 933-6690
(815) 933-9937
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/01/2011
Last updated
07/01/2011
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