Gillespie 694140
NPI #1881738979 in Jacksonville, Illinois
Provider Information
- NPI Number
- 1881738979
- Entity Type
- Organization
- Organization Name
- Gillespie 694140
- Primary Specialty
- Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Feb 20, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 1201 S MAIN ST
- City
- Jacksonville
- State
- Illinois
- ZIP Code
- 62650-3339
- Phone
- (217) 479-2120
Authorized Official
- Name
- SUSIE PENNELL
- Title
- ADMINISTRATIVE ASSISTANT
- Phone
- (217) 479-2120
Specialties & Taxonomy Codes
| Specialty |
|---|
| Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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