| The Vine & The Branches Llc | |
|
112 S Main St Washington IL 61571-2552 | |
| (309) 635-5655 | |
| Not Available |
| Full Name | The Vine & The Branches Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 112 S Main St, Washington, Illinois |
| Authorized Official Name and Position | Angella Maria Lewis (OWNER) |
| Authorized Official Contact | 3096355655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Vine & The Branches Llc 112 S Main St Washington IL 61571-2552 Ph: (309) 635-5655 | The Vine & The Branches Llc 112 S Main St Washington IL 61571-2552 Ph: (309) 635-5655 |
| NPI Number | 1356029847 |
|---|---|
| Provider Enumeration Date | 07/06/2023 |
| Last Update Date | 07/06/2023 |
| Certification Date | 07/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356029847 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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