Healthcare Provider Details

I. General information

NPI: 1154573467
Provider Name (Legal Business Name): KLEEMAN VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 KLEEMANN DR
CLINTON IL
61727-9465
US

IV. Provider business mailing address

PO BOX 616
CLINTON IL
61727-0616
US

V. Phone/Fax

Practice location:
  • Phone: 217-935-6655
  • Fax: 217-935-5305
Mailing address:
  • Phone: 217-935-6655
  • Fax: 217-935-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL D LIETZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-935-9496