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General NPI Number Information
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NPI Number | 1861561995
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Entity Type | Organization
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Legal Business Name | MACON RESOURECES, INC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2121 HUBBARD AVE
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City | DECATUR
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State | IL
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Zip | 62526-2876
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Country | US
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Telephone | 217-875-8889
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Fax | 217-875-8899
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Provider Business Mailing Address
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Address Line | 2121 HUBBARD AVE P.O. BOX 2760
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City | DECATUR
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State | IL
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Zip | 62526-2876
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Country | US
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Telephone | 217-875-8889
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Fax | 217-875-8899
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Authorized Official
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Title or Position | DIRECTOR OF COMM LIVING SERVICES
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Name | MS. JANET L SHELTON
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Credential |
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Telephone | 217-875-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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