Healthcare Provider Details

I. General information

NPI: 1417313057
Provider Name (Legal Business Name): OUR DIRECTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E HERRIN ST
HERRIN IL
62948-3451
US

IV. Provider business mailing address

PO BOX 2084
HERRIN IL
62948-5284
US

V. Phone/Fax

Practice location:
  • Phone: 618-988-8178
  • Fax: 618-942-7936
Mailing address:
  • Phone: 618-988-8178
  • Fax: 618-942-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number200500002M
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number200500002M
License Number StateIL

VIII. Authorized Official

Name: MS. VERNA WEBB
Title or Position: DIRECTOR
Credential:
Phone: 618-988-8178