Glen Brook

NPI #1629292081 in Vienna, Illinois

Provider Information

NPI Number: 1629292081
Entity Type: Organization
Organization Name: Glen Brook
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Apr 13, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 801 NORTH 1ST STREET
City: Vienna
State: Illinois
ZIP Code: 62995-1544
Phone: (618) 658-2005

Authorized Official

Name: JAMES KELLER
Title: ADMINISTRATOR
Phone: (618) 833-5070

Specialties & Taxonomy Codes

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

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