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General NPI Number Information
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NPI Number | 1154465243
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Entity Type | Organization
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Legal Business Name | BUSHNELL DIX HILL JONES 694110
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 S MAIN ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-3339
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Country | US
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Telephone | 217-479-2120
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Fax | 217-243-8920
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Provider Business Mailing Address
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Address Line | 1201 S MAIN ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-3339
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Country | US
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Telephone | 217-479-2120
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Fax | 217-243-8920
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Authorized Official
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Title or Position | ADMINISTRATIVE ASST
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Name | SUSIE PENNELL
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Credential |
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Telephone | 217-479-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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