National Provider Identifier Database

CEREBRAL PALSY OF SOUTHWESTERN ILLINOIS
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities


Contact Information

CEREBRAL PALSY OF SOUTHWESTERN ILLINOIS
138 LINCOLN PLACE CT
SUITE 101
BELLEVILLE, IL62221-5884
Phone: 618-233-0210
Fax:
Website:
Specialty Taxonomy Code
* Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities 320900000X
Case Management 251B00000X

* Indicates primary specialty

NPI Profile & details for CEREBRAL PALSY OF SOUTHWESTERN ILLINOIS

NPI Number 1427426055
Legal business name
LBN
CEREBRAL PALSY OF SOUTHWESTERN ILLINOIS
Authorized official JEANETTE HAEGE - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 09/14/2015
Last updated 10/06/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers
  • IL License #: 199100130S

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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