Provider Demographics
NPI:1114275435
Name:WEBSTER-CANTRELL HALL
Entity Type:Organization
Organization Name:WEBSTER-CANTRELL HALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-423-6961
Mailing Address - Street 1:1942 E CANTRELL ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3214
Mailing Address - Country:US
Mailing Address - Phone:217-423-6961
Mailing Address - Fax:
Practice Address - Street 1:1220 UNDERWOOD CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1983
Practice Address - Country:US
Practice Address - Phone:217-233-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060479-11322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid