Piasa Manor

NPI #1346369642 in Godfrey, Illinois

Provider Information

NPI Number: 1346369642
Entity Type: Organization
Organization Name: Piasa Manor
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Mar 28, 2007
Last Updated: Aug 4, 2008

Practice Location

Address: 110 N ALBY CT
City: Godfrey
State: Illinois
ZIP Code: 62035-1963
Phone: (618) 466-9242

Authorized Official

Name: MRS. CAROL ANN DODD
Title: QMRP
Phone: (618) 466-9242

Specialties & Taxonomy Codes

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

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