Provider Demographics
NPI:1063503647
Name:LIVING IN A FAMILY ENVIRONMENT MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:LIVING IN A FAMILY ENVIRONMENT MANAGEMENT CORPORATION
Other - Org Name:LIVING IN A FAMILY ENVIRONMENT MANAGEMENT CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-967-7106
Mailing Address - Street 1:3136 MYERS LN
Mailing Address - Street 2:
Mailing Address - City:MAKANDA
Mailing Address - State:IL
Mailing Address - Zip Code:62958-5200
Mailing Address - Country:US
Mailing Address - Phone:618-967-7106
Mailing Address - Fax:618-549-8163
Practice Address - Street 1:3136 MYERS LN
Practice Address - Street 2:
Practice Address - City:MAKANDA
Practice Address - State:IL
Practice Address - Zip Code:62958-5200
Practice Address - Country:US
Practice Address - Phone:618-967-7106
Practice Address - Fax:618-549-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201300019S320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201300019SMedicaid