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General NPI Number Information
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NPI Number | 1053473801
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Entity Type | Organization
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Legal Business Name | THE WILLIAM M BEDELL ACHIEVEMENT AND RESOURCE CENTER
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 S MAIN ST
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City | WOOD RIVER
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State | IL
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Zip | 62095
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Country | US
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Telephone | 618-251-2175
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Fax | 618-251-6294
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Provider Business Mailing Address
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Address Line | BOX 349 400 S MAIN ST
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City | WOOD RIVER
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State | IL
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Zip | 62095
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Country | US
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Telephone | 618-251-2175
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Fax | 618-251-6294
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GARY J OSBORNE
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Credential |
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Telephone | 618-251-2175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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