Organization
HOME AND ENVIRONMENTS FOR LIVING AND PROGRAMS
Active
Other names
Lebanon Terrace
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHERINE A BROOKSHIRE (ADMINISTRATOR)
(217) 529-9632
Entity
Organization
Contact information
Practice address
221 E 3RD ST, LEBANON, IL 62254-1668
(618) 537-4133
(618) 537-4156
Mailing address
40 ADLOFF LN STE 5, SPRINGFIELD, IL 62703-4496
(217) 529-9632
(217) 529-9635
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0038430
IL
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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