Supported Residential
NPI #1578266342 in Bloomington, Illinois
Provider Information
- NPI Number
- 1578266342
- Entity Type
- Organization
- Organization Name
- Supported Residential
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MCLEAN CO CTR FOR HUMAN SERVICES
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- Mar 22, 2023
- Last Updated
- Mar 22, 2023
Practice Location
- Address
- 710 W MULBERRY ST
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61701-2868
- Phone
- (309) 827-0067
Authorized Official
- Name
- JUNE PETERSON -MIDDLEBROOKS
- Title
- ACCOUNTS RECEIVABLE
- Phone
- (309) 827-5351
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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