Organization
SACRAE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAULA JO RUSH SHUMPERT DT (MANAGER)
(618) 550-8898
Entity
Organization
Contact information
Practice address
2661 N ILLINOIS ST STE 126, SWANSEA, IL 62226-2302
(618) 550-8898
Mailing address
1442 SCHWARZ MEADOW DR, O FALLON, IL 62269-6709
(618) 550-8898
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/06/2007
Last updated
08/22/2020
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