Willowglen Academy Illinois

NPI #1811449523 in Freeport, Illinois

Provider Information

NPI Number: 1811449523
Entity Type: Organization
Organization Name: Willowglen Academy Illinois
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Oct 28, 2016
Last Updated: Oct 28, 2016

Practice Location

Address: 701 W LAMM RD
City: Freeport
State: Illinois
ZIP Code: 61032-9630
Phone: (815) 233-6162

Authorized Official

Name: SAMANTHA JO CUSIMANO
Title: QIDP
Phone: (815) 233-6162

Specialties & Taxonomy Codes

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

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