Provider Demographics
NPI:1215302583
Name:EPILEPSY FOUNDATION OF GREATER SOUTHERN ILLINOIS
Entity type:Organization
Organization Name:EPILEPSY FOUNDATION OF GREATER SOUTHERN ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-236-2181
Mailing Address - Street 1:3515 N BELT W
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5944
Mailing Address - Country:US
Mailing Address - Phone:618-236-2181
Mailing Address - Fax:618-236-3654
Practice Address - Street 1:3515 N BELT W
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5944
Practice Address - Country:US
Practice Address - Phone:618-236-2181
Practice Address - Fax:618-236-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL199100111S311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home