Organization
ALCOHOLIC REHABILITATION COMMUNITY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARY GREEN CADC (EXECUTIVE DIRECTOR)
(618) 877-4987
Entity
Organization
Contact information
Practice address
1313 21ST ST, GRANITE CITY, IL 62040-4756
(618) 877-4987
(618) 877-4930
Mailing address
1313 21ST ST, GRANITE CITY, IL 62040-4756
(618) 877-4987
(618) 877-4930
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
A06870001A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A06870001A
DHS - OASA
IL
Enumeration date
04/16/2007
Last updated
08/22/2020
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