Provider Demographics
NPI:1255530945
Name:THE MARY BRYANT HOME ASSOCIATION
Entity type:Organization
Organization Name:THE MARY BRYANT HOME ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-529-1611
Mailing Address - Street 1:2960 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4315
Mailing Address - Country:US
Mailing Address - Phone:217-529-1611
Mailing Address - Fax:217-529-6975
Practice Address - Street 1:2960 STANTON ST.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4385
Practice Address - Country:US
Practice Address - Phone:217-529-1611
Practice Address - Fax:217-529-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility