ILLINOIS DEPARTMENT OF HUMAN SERVICES (NPI# 1154475986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154475986 |
Entity Type | Organization |
Organization Name | ILLINOIS DEPARTMENT OF HUMAN SERVICES |
Other Organization Name | CLYDE CHOATE MENTAL HEALTH DEVELOPMENTAL CENTER |
Practice Address |
1000 N Main St Anna IL 62906-1652 |
Practice Telephone | 6188335161 |
Practice Fax Number | 6188333432 |
Mailing Telephone | 6188335161 |
Mailing Fax Number | 6188333432 |
Enumeration Date | 2007-01-22 |
Last Update Date | 2018-12-19 |
Authorized Official Name | PAM MEHRLE (PHARMACY MANAGER) |
Authorized Official Telephone | 6188335161 |
Authorized Official Credential | RPH |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 333600000X | Pharmacy | Suppliers | ||
Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
054017322 | IL | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
PK | 2023357 | 01 |
Other Name | Type Code |
---|---|
CLYDE CHOATE MENTAL HEALTH DEVELOPMENTAL CENTER | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467430124 | Illinois Department of Human Services | Psychiatric Hospital | 901 Southwind Dr, Springfield, IL 62703-5125 | 2006-01-04 |
1376525204 | Illinois Department of Human Services | Intermediate Care Facility, Mentally Retarded | 1120 Washington Ave, Dixon, IL 61021-1258 | 2005-11-16 |
1356338198 | Illinois Department of Human Services | Psychiatric Hospital | 4402 N Main St, Rockford, IL 61103-1278 | 2005-10-05 |
1053535864 | Illinois Department of Human Services | Intermediate Care Facility, Mentally Retarded | 114 N Orchard Dr, Park Forest, IL 60466-1200 | 2007-04-12 |
1154453991 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1000 N Main St, Anna, IL 62906-1652 | 2007-03-09 |
1639214760 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1535 W Mccord St, Centralia, IL 62801-5805 | 2007-02-20 |
1548305675 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1535 W Mccord St, Centralia, IL 62801-5805 | 2007-02-20 |
1437294568 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1535 W Mccord St, Centralia, IL 62801-5805 | 2007-02-20 |
1346385473 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1535 W Mccord St, Centralia, IL 62801-5805 | 2007-02-20 |
1053456186 | Illinois Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1535 W Mccord St, Centralia, IL 62801-5805 | 2007-02-20 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | ILLINOIS DEPARTMENT OF HUMAN SERVICES | 401 S Clinton St, Chicago, IL 60607-3800 |
Street Address |
1000 N MAIN ST |
City | ANNA |
State | IL |
Zip Code | 62906-1652 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184137234 | Taylor Bre-an Phillips | Licensed Practical Nurse | 1000 N Main St, Anna, IL 62906-1652 | 2017-11-12 |
1558873414 | Amy M Miller | Psychologist | 1000 N Main St, Anna, IL 62906-1652 | 2017-11-01 |
1861915761 | Krystin Angel Grant | Nurse's Aide | 1000 N Main St, Anna, IL 62906-1652 | 2017-07-23 |
1295107696 | Richard Lamb | Dentist | 1000 N Main St, Anna, IL 62906-1652 | 2015-10-24 |
1790923399 | Percy Chester Myers | Anesthesiology | 1000 N Main St, Anna, IL 62906-1652 | 2009-02-04 |
1396956645 | Vikas Arora | Psychiatry & Neurology | 1000 N Main St, Choate Mental Health Hospital and Dev Center, Anna, IL 62906-1652 | 2007-05-25 |
1306978127 | Unit 1072 Upper Treatment Complex | Psychiatric Hospital | 1000 N Main St, Anna, IL 62906-1652 | 2007-03-09 |
1063544823 | Unit 4463 Cypress Hall Lower | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1000 N Main St, Anna, IL 62906-1652 | 2007-03-09 |
1437281292 | Unit 4466 Sycamore Hall Upper | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1000 N Main St, Anna, IL 62906-1652 | 2007-03-09 |
1104958966 | Unit 4464 Cypress Hall Upper | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1000 N Main St, Anna, IL 62906-1652 | 2007-03-09 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265711600 | Community Integrated Living, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 110 Jeni Lane, Anna, IL 62906 | 2011-08-16 |
1508153768 | Union County Counseling Services Inc | Clinic/Center | 202 South St, Anna, IL 62906 | 2011-07-07 |
1326335589 | Union County Counseling Services Inc | Clinic/Center | 302 South St, Anna, IL 62906 | 2011-07-07 |
1063709228 | Union County Counseling Services Inc | Community Based Residential Treatment Facility, Mental Illness | 311 W Vienna St, Anna, IL 62906 | 2011-07-07 |
1598920928 | Steven Wayne Vincent | Dentist | 131 West Vienna Street, Anna, IL 62906 | 2008-07-24 |
1427236900 | Cardinal House Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 200 Douglas Street, Anna, IL 62906 | 2008-02-06 |
1992913719 | High Chiropractic Center | Chiropractor | 35 Walton Lane, Anna, IL 62906 | 2007-05-18 |
1023235678 | Chuck C. Bugle | Psychologist | 311 W. Spring St., Anna, IL 62906 | 2007-04-18 |
1922194604 | Nancy Kay Webb | Physical Therapist | 515 E Vienna Street, Suite I, Anna, IL 62906 | 2006-10-04 |
1144242918 | William W Mings | Psychiatry & Neurology | 204 South St, Anna, IL 62906 | 2006-07-24 |
Find all providers in zip 62906 |
Taxonomy Code | 3336L0003X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Long Term Care Pharmacy |
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912512989 | Millenium Pharmacy Ltd | Pharmacy | 10604 Southwest Hwy Ste 102, Chicago Ridge, IL 60415-2704 | 2020-09-15 |
1992265235 | Illini Clinic Pharmacy Inc | Pharmacy | 211 S 1st Street, Alpha, IL 61413 | 2019-03-22 |
1750841342 | Illini Clinic Pharmacy Inc | Pharmacy | 855 Illini Dr Ste 200, Silvis, IL 61282-2904 | 2019-03-21 |
1679039358 | Remedi Seniorcare of Chicago, LLC | Pharmacy | 3600 Lacey Road, Suite 500, Downers Grove, IL 60515 | 2019-02-18 |
1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
1538672449 | Wear Ltc | Pharmacy | 527 N Madison St Ste B, Carthage, IL 62321-1034 | 2017-11-14 |
1124546031 | Symbria Rx Services, LLC. | Pharmacy | 3200 Grant St Rm 41, Evanston, IL 60201-1903 | 2017-08-31 |
1699146720 | Pharmblue Illinois LLC | Pharmacy | 2960 Chartres St Ste 100, La Salle, IL 61301-1097 | 2015-10-15 |
1194144691 | Lifemed Illinois, LLC | Pharmacy | 881 Il Route 83, Bensenville, IL 60106-1219 | 2014-04-11 |
1205250412 | Becks Long Term Care Pharmacy Inc | Pharmacy | 1413 Locust Street, Eldorado, IL 62930 | 2014-02-07 |
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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.