Healthcare Provider Details

I. General information

NPI: 1720114788
Provider Name (Legal Business Name): ARCHWAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 W MAIN ST
CARBONDALE IL
62901-1000
US

IV. Provider business mailing address

PO BOX 1180
CARBONDALE IL
62903-1180
US

V. Phone/Fax

Practice location:
  • Phone: 618-529-5944
  • Fax: 618-529-5785
Mailing address:
  • Phone: 618-529-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEANNA CRUSE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 618-529-5944