Organization
COMWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BAUER (IT COORDINATOR)
(618) 282-6233
Entity
Organization
Contact information
Practice address
3298 DAWNVIEW ROAD, CHESTER, IL 62233
(618) 826-4531
(618) 826-3461
Mailing address
10257 STATE ROUTE 3, RED BUD, IL 62278-4418
(618) 282-6233
(618) 282-6220
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/03/2007
Last updated
02/04/2021
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