Unit 4464 Cypress Hall Upper

NPI #1104958966 in Anna, Illinois

Provider Information

NPI Number: 1104958966
Entity Type: Organization
Organization Name: Unit 4464 Cypress Hall Upper
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Mar 9, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 1000 N MAIN ST
City: Anna
State: Illinois
ZIP Code: 62906-1652
Phone: (618) 833-5161

Authorized Official

Name: BRUCE BROWN
Title: REIMBURSEMENT OFFICER II
Phone: (618) 833-5161

Specialties & Taxonomy Codes

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

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