Healthcare Provider Details

I. General information

NPI: 1942491162
Provider Name (Legal Business Name): MARION COUNTY HORIZON CENTER D/B/A RICHLAND MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 WEST MAIN ST
OLNEY IL
62450
US

IV. Provider business mailing address

122 NORTH HOTZE RD P.O. BOX 745
SALEM IL
62881
US

V. Phone/Fax

Practice location:
  • Phone: 618-395-2437
  • Fax: 618-392-2673
Mailing address:
  • Phone: 618-548-0309
  • Fax: 618-548-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number0036285
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number201200007M
License Number StateIL

VIII. Authorized Official

Name: MRS. RITA M ARMBRUST
Title or Position: MANAGER
Credential:
Phone: 618-548-0309