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General NPI Number Information
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NPI Number | 1508290008
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Entity Type | Organization
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Legal Business Name | HOYLETON YOUTH AND FAMILY SERVICES
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 300 N CHURCH ST
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City | BELLEVILLE
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State | IL
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Zip | 62220-4024
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Country | US
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Telephone | 618-493-7382
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Fax | 618-493-6390
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Provider Business Mailing Address
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Address Line | 350 N MAIN ST
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City | HOYLETON
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State | IL
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Zip | 62803-2006
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Country | US
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Telephone | 618-493-7382
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Fax | 618-493-6390
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MR. CHRISTOPHER L COX
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Credential | LCSW
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Telephone | 618-493-7382
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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 | IL
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