PIASA MANOR NPI 1346369642

NPI Information

NPI: 1346369642
Provider Name: PIASA MANOR
Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
Entity Type: Organization
Address:
110 N ALBY CT
GODFREY, IL
ZIP 62035
Phone: (618) 466-9242
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PIASA MANOR is a residential treatment facility, intellectual and/or developmental disabilities in Godfrey, IL. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. PIASA MANOR NPI is 1346369642. The provider is registered as an organization entity type.

The provider's business location address is:

110 N ALBY CT
GODFREY, IL
ZIP 62035-963
Phone: (618) 466-9242
Fax: (618) 466-9517

The provider's authorized official is Carol Ann Dodd .
The authorized official title is Qmrp and has the following contact phone number (618) 466-9242.

The enumeration date for this NPI number is 3/28/2007 and was last updated on 8/4/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities		0038422	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	14G103	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS
2	371272004	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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