OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC (NPI# 1093110066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093110066 |
| Entity Type | Organization |
| Organization Name | OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC |
| Other Organization Name | GLENWOOD HOUSE |
| Practice Address |
600 West 12th Street Streator IL 61364 |
| Mailing Address |
1718 N 2525th Rd Ottawa IL 61350-9329 |
| Practice Telephone | 8156731182 |
| Practice Fax Number | 8156733231 |
| Mailing Telephone | 8154340737 |
| Mailing Fax Number | 8154340493 |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2014-11-03 |
| Authorized Official Name | MRS. BETH ANN MANGOLD (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8154340737 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 14G282 | 05 |
| Other Name | Type Code |
|---|---|
| Glenwood House | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477958528 | Ottawa Friendship House Work Activity Center, Inc | Intermediate Care Facility, Mentally Retarded | 600 Grover Ave, Ottawa, IL 61350-4140 | 2014-10-31 |
| Street Address |
600 WEST 12TH STREET |
| City | STREATOR |
| State | IL |
| Zip Code | 61364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306278973 | Robert Henry Harms | Veterinarian | 701 Oakley Ave, Streator, IL 61364 | 2013-08-06 |
| 1518202373 | Jessica L Hartman | Nurse Practitioner | 2377 N Bloomington St, Streator, IL 61364 | 2012-12-05 |
| 1992049563 | Wendell Allen Sargent | Dentist | 106 Boys St, Streator, IL 61364 | 2012-11-20 |
| 1215266036 | Sudha Pravinkumar | Internal Medicine | 2377 Bloomington Ave, Ste B, Streator, IL 61364 | 2009-12-08 |
| 1497988984 | Lifetime Medical Supply Inc. | Durable Medical Equipment & Medical Supplies | 1215 N Ottercreek Rd., Streator, IL 61364 | 2009-08-31 |
| 1275709727 | Fresenius Medical Care of Illinois LLC | Clinic/Center | 2356 North Bloomington St, Streator, IL 61364 | 2008-05-05 |
| 1487701793 | Tammy R Thieme | Social Worker | 17 North Point Plaza, Streator, IL 61364 | 2007-01-05 |
| 1629185376 | Gary Finkelstein Md Eye Associates Sc | Ophthalmology | 102 West Elm Street, Streator, IL 61364 | 2006-08-25 |
| 1134150808 | Indra Pal Mdsc | Internal Medicine | 104 Sixth Street, Streator, IL 61364 | 2006-07-05 |
| 1902843634 | Dawn J Mueller | Physical Therapist | 312 N Sterling St., Streator, IL 61364 | 2006-06-01 |
| Find all providers in zip 61364 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205014727 | Glenwood House Residential Care, Inc. | Intermediate Care Facility, Mentally Retarded | 300 W 12th St, Streator, IL 61364-3301 | 2008-02-06 |
| 1114117231 | Streator Unlimited Inc | Intermediate Care Facility, Mentally Retarded | 305 N Sterling St, Streator, IL 61364-2369 | 2007-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871039669 | Mount St Joseph | Intermediate Care Facility, Mentally Retarded | 24955 N Us Highway 12, Lake Zurich, IL 60047-8919 | 2017-01-17 |
| 1447792221 | Shore Community Services, Inc. | Intermediate Care Facility, Mentally Retarded | 8350 Laramie Ave, Skokie, IL 60077-2461 | 2016-11-10 |
| 1770930968 | Community Support Systems | Intermediate Care Facility, Mentally Retarded | 2311 Veterans Drive, Effingham, IL 62401 | 2016-05-18 |
| 1265898266 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 102 S Douglas St, Mc Leansboro, IL 62859-1637 | 2016-01-06 |
| 1164888160 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 1406 W Delaware St, Fairfield, IL 62837-2336 | 2016-01-06 |
| 1376909374 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 416 Chula Vista Dr, Belleville, IL 62221-3160 | 2016-01-06 |
| 1437515434 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 206 N Washington St, Mc Leansboro, IL 62859-1049 | 2016-01-06 |
| 1790141885 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 212 Turning Leaf Cir, Belleville, IL 62221-6747 | 2016-01-06 |
| 1790141794 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 867 County Road 2150 E, Fairfield, IL 62837-2824 | 2016-01-06 |
| 1255797254 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 9135 N Spring Garden Ln, Mount Vernon, IL 62864-6624 | 2016-01-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.