Organization
UNIT 3021 C&A REDBUD UPPER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE BROWN (REIMBURSEMENT OFFICER II)
(618) 833-5161
Entity
Organization
Contact information
Practice address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161
Mailing address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G045
—
IL
Enumeration date
03/08/2007
Last updated
08/22/2020
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