West Lake Residential - Building C

NPI 1023263043 - Community Based Residential Treatment Facility, Mental Illness - 320800000X

NPI Details
NPI 1023263043
Enumeration Date 11/18/2008
Last Updated 11/18/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name ROBYN L ROBYN
Position ADMINISTRATOR
Phone (217) 588-7932
Fax (217) 529-9803
Practice Location
200 W LAKE DR
BUILDING C
SPRINGFIELD IL, 62703-4956, US
Phone (217) 588-7932
Fax (217) 529-9803
Business Location
710 N 8TH ST
SPRINGFIELD IL, 62702-6324, US
Phone (217) 525-1064
Fax (217) 525-1651
Toxanomy
Taxonomy Code 320800000X
License State
License Number
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According to our database, West Lake Residential - Building C NPI is 1023263043, taxonomy code is 320800000X West Lake Residential - Building C physically located at 200 W Lake Dr, Springfield IL, 62703-4956. NPI Number 1033115704 has the healthcare provider type.

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1023263043 NPI number is provided on an as is basis without warranty of any kind. 1023263043 is maintained by the National Plan & Provider Enumeration System. The contents of West Lake Residential - Building C are for informational purposes only.