=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467993154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOYLETON YOUTH AND FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2017
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6015 AND 6017 WEST A STREET UNIT 6015 AND 6017
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-688-4727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 EXECUTIVE DR SUITE 200
-----------------------------------------------------
City | FAIRVIEW HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62208-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-688-4727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MR. CHRISTOPHER COX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-688-4735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | 033699
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------