Organization Name: | PIASA MANOR |
NPI Number: | 1346369642 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CAROL ANN DODD (QMRP) |
Mailing Address: | 110 N Alby Ct Godfrey |
State: | IL US |
Postal Code: | 620351963 |
Phone Number: | 6184669242 |
Fax Number: | 6184669517 |
NPI Enumeration Date: | 03/28/2007 |
NPI Last Update Date: | 08/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | 0038422 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |