Lebanon Terrace

NPI #1104945716 in Lebanon, Illinois

Provider Information

NPI Number: 1104945716
Entity Type: Organization
Organization Name: Lebanon Terrace
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Mar 28, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 221 E 3RD ST
City: Lebanon
State: Illinois
ZIP Code: 62254-1668
Phone: (618) 537-4133

Authorized Official

Name: MS. DONNA L JONES
Title: QMRP
Phone: (618) 537-4133

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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