Provider Demographics
NPI:1053473801
Name:THE WILLIAM M BEDELL ACHIEVEMENT AND RESOURCE CENTER
Entity Type:Organization
Organization Name:THE WILLIAM M BEDELL ACHIEVEMENT AND RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-251-2175
Mailing Address - Street 1:BOX 349
Mailing Address - Street 2:400 S MAIN ST
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095
Mailing Address - Country:US
Mailing Address - Phone:618-251-2175
Mailing Address - Fax:618-251-6294
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095
Practice Address - Country:US
Practice Address - Phone:618-251-2175
Practice Address - Fax:618-251-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services