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General NPI Number Information
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NPI Number | 1609333129
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Entity Type | Organization
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Legal Business Name | THE ESTHER SERVICES PROJECT OF SO IL, INC
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 105 EAST ST
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City | XENIA
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State | IL
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Zip | 62899-1274
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Country | US
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Telephone | 618-572-8234
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Fax | 618-801-1442
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Provider Business Mailing Address
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Address Line | 105 EAST ST
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City | XENIA
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State | IL
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Zip | 62899-1274
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Country | US
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Telephone | 618-572-8234
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Fax | 618-801-1442
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Authorized Official
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Title or Position | OWNER/EX DIRECTOR
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Name | MS. PAMELA M SMITH
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Credential |
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Telephone | 618-572-8234
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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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