Organization
GROW IN ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL MUSSEY (PRESIDENT)
(217) 352-6989
Entity
Organization
Contact information
Practice address
1108 E COURT ST, KANKAKEE, IL 60901-4257
(815) 933-6690
Mailing address
2403 W SPRINGFIELD AVE, PO BOX 3667, CHAMPAIGN, IL 61821-2883
(217) 352-6989
(217) 352-8530
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
05005
IL
Other
Enumeration date
01/04/2008
Last updated
01/04/2008
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