| Intensive Out-patient Care | |
|
2 Club Centre Ct Suite 1 Edwardsville IL 62025-3503 | |
| (618) 656-7064 | |
| (618) 656-9084 |
| Full Name | Intensive Out-patient Care |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2 Club Centre Ct, Edwardsville, Illinois |
| Authorized Official Name and Position | Jennifer Mary Manning (DIRECTOR) |
| Authorized Official Contact | 6186567064 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intensive Out-patient Care 2 Club Centre Ct Suite 1 Edwardsville IL 62025-3503 Ph: (618) 656-7064 | Intensive Out-patient Care 2 Club Centre Ct Suite 1 Edwardsville IL 62025-3503 Ph: (618) 656-7064 |
| NPI Number | 1255715280 |
|---|---|
| Provider Enumeration Date | 07/20/2015 |
| Last Update Date | 07/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255715280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 371259842 (Illinois) | Primary |
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