1275725608 NPI number — MARION COUNTY HORIZON CENTER D/B/A OUR PLACE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275725608 NPI number — MARION COUNTY HORIZON CENTER D/B/A OUR PLACE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION COUNTY HORIZON CENTER D/B/A OUR PLACE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275725608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 NORTH HOTZE ROAD
Provider Second Line Business Mailing Address:
P.O. BOX 745
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-548-0309
Provider Business Mailing Address Fax Number:
618-548-3720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURPHYSBORO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62966-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-687-1415
Provider Business Practice Location Address Fax Number:
618-684-4361
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARMBRUST
Authorized Official First Name:
RITA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
618-548-0309

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  0036293 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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