Provider Demographics
NPI:1275725608
Name:MARION COUNTY HORIZON CENTER D/B/A OUR PLACE
Entity Type:Organization
Organization Name:MARION COUNTY HORIZON CENTER D/B/A OUR PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARMBRUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-0309
Mailing Address - Street 1:122 NORTH HOTZE ROAD
Mailing Address - Street 2:P.O. BOX 745
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881
Mailing Address - Country:US
Mailing Address - Phone:618-548-0309
Mailing Address - Fax:618-548-3720
Practice Address - Street 1:301 N 13TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2000
Practice Address - Country:US
Practice Address - Phone:618-687-1415
Practice Address - Fax:618-684-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036293315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6296604Medicaid