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General NPI Number Information
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NPI Number | 1073643953
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Entity Type | Organization
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Legal Business Name | RESIDENTIAL HORIZONS INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 815 E VINE ST
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City | TAYLORVILLE
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State | IL
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Zip | 62568-1932
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Country | US
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Telephone | 217-287-1484
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Fax | 217-287-1010
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | PANAMA
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State | IL
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Zip | 62077-0640
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Country | US
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Telephone | 217-287-1484
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Fax | 217-287-1010
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ANNA MARIE BRACKENBUSH
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Credential |
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Telephone | 217-287-1484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 0040766
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License Number State | IL
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