ILLINOIS DEPARTMENT OF HUMAN SERVICES (NPI# 1154453991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154453991 |
Entity Type | Organization |
Organization Name | ILLINOIS DEPARTMENT OF HUMAN SERVICES |
Other Organization Name | CHOATE MENTAL HEALTH & DEVELOPMENTAL CENTER |
Practice Address |
1000 N Main St Anna IL 62906-1652 |
Practice Telephone | 6188335161 |
Mailing Telephone | 6188335161 |
Enumeration Date | 2007-03-09 |
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 |
---|---|---|---|---|---|
N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | 14G045 | 05 |
Other Name | Type Code |
---|---|
Choate Mental Health & 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 |
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 |
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 |
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 | 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 |
---|---|---|---|---|
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.