Organization
VILLAGE INN COBDEN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT CHAMNESS (OWNER/PRESIDENT)
(618) 893-4222
Entity
Organization
Contact information
Practice address
114 ASH STREET, COBDEN, IL 62920-0457
(618) 893-4222
(618) 833-5295
Mailing address
PO BOX 457, COBDEN, IL 62920-0457
(618) 893-4222
(618) 833-5295
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
201000004M
IL
Other
Enumeration date
02/22/2008
Last updated
06/24/2016
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