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General NPI Number Information
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NPI Number | 1174356471
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Entity Type | Organization
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Legal Business Name | COMWELL
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 207 N JAMES ST
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City | SPARTA
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State | IL
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Zip | 62286-1213
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Country | US
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Telephone | 618-282-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 10257 STATE ROUTE 3
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City | RED BUD
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State | IL
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Zip | 62278-4418
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Country | US
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Telephone | 618-282-6233
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Fax |
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Authorized Official
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Title or Position | BILLING/CREDENTIALING
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Name | ASHLEY RENNER
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Credential | AM
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Telephone | 618-282-6233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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