ILLINOIS DEPARTMENT OF HUMAN SERVICES (NPI# 1376525204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376525204 |
| Entity Type | Organization |
| Organization Name | ILLINOIS DEPARTMENT OF HUMAN SERVICES |
| Other Organization Name | JACK MABLEY DEVELOPMENTAL CENTER |
| Practice Address |
1120 Washington Ave Dixon IL 61021-1258 |
| Practice Telephone | 8152888301 |
| Practice Fax Number | 8152888398 |
| Mailing Telephone | 8152888301 |
| Mailing Fax Number | 8152888398 |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2016-12-22 |
| Authorized Official Name | DEBRA MUHLSTADT (FISCAL ADMINISTRATOR, SODC OPERATIO) |
| Authorized Official Telephone | 8152888335 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 830600 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Jack Mabley Developmental Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467430124 | Illinois Department of Human Services | Psychiatric Hospital | 901 Southwind Dr, Springfield, IL 62703-5125 | 2006-01-04 |
| 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 |
| 1932244860 | Illinois Department of Human Services | Psychiatric Unit | 4500 College Ave, Alton, IL 62002 | 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 |
1120 WASHINGTON AVE |
| City | DIXON |
| State | IL |
| Zip Code | 61021-1258 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770628398 | Jack Mabley Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1120 Washington Ave, Dixon, IL 61021-1258 | 2007-02-21 |
| 1619012234 | Jack Mabley Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1120 Washington Ave, Dixon, IL 61021-1258 | 2007-02-21 |
| 1528103140 | Jack Mabley Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1120 Washington Ave, Dixon, IL 61021-1258 | 2007-02-21 |
| 1831234475 | Jack Mabley Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1120 Washington Ave, Dixon, IL 61021-1258 | 2007-02-21 |
| 1285779892 | Jack Mabley Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1120 Washington Ave, Dixon, IL 61021-1258 | 2007-02-21 |
| 1326183948 | Jack Mabley Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1120 Washington Ave, Dixon, IL 61021-1258 | 2007-02-21 |
| 1104961820 | Jack Mabley Dvelopmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1120 Washington Ave, Dixon, IL 61021-1258 | 2007-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699331082 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1600 South Galena Ave, Dixon, IL 61021 | 2019-05-12 |
| 1285135590 | Richard Allen Sibert | Counselor | 325 Il Route 2,dixon Il, Dixon, IL 61021 | 2018-02-22 |
| 1518485432 | Madeline Luniewicz | Counselor | 325 Il-2, Dixon, IL 61021 | 2017-08-30 |
| 1669992566 | Nicole Marie Shaffer | Specialist/Technologist | 650 Reynoldswood Road, Dixon, IL 61021 | 2017-06-21 |
| 1346660446 | Lydia Sitter | Audiologist | 215 3. 1st Street, Suite 317, Ksb Medical Group, Dixon, IL 61021 | 2014-04-16 |
| 1053600080 | Janet I. Malmberg | Nurse Practitioner | 309 South Galena Ave, Suite 100, Dixon, IL 61021 | 2011-03-30 |
| 1376775262 | Kelly L Klein | Optometrist | 511 Palmyra Street, Ksb Eye & Vision Care, Dixon, IL 61021 | 2009-08-11 |
| 1013119106 | Michael Joseph Sarno | Physical Therapist | 401 E. First Street, Dixon, IL 61021 | 2007-06-01 |
| 1891905600 | Thomas G. Gehlbach | Internal Medicine | 215 E 1st St Ste 111, Dixon, IL 61021 | 2007-05-23 |
| 1699987230 | Sameer Jain | Family Medicine | 102 S. Hennepin Ave., Ksb Medical Group, Dixon, IL 61021 | 2007-05-04 |
| Find all providers in zip 61021 | ||||
| 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 |
|---|---|---|---|---|
| 1295067247 | Kreider Services Inc | Intermediate Care Facility, Mentally Retarded | 726 N Ottawa Ave, Dixon, IL 61021-1632 | 2010-02-02 |
| 1073843165 | Kreider Services Incorporated | Intermediate Care Facility, Mentally Retarded | 1201 Middle Rd, Dixon, IL 61021-3977 | 2010-01-12 |
| 1669667861 | Crossroads Living Center Inc. | Intermediate Care Facility, Mentally Retarded | 880 Alexander Dr, Dixon, CA 95620-4102 | 2007-09-11 |
| 1871787572 | Crossroads Living Center Inc. | Intermediate Care Facility, Mentally Retarded | 1250 Woodman Way, Dixon, CA 95620-2142 | 2007-09-05 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.