BUSHNELL DIX HILL JONES 694110 (NPI# 1154465243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154465243 |
| Entity Type | Organization |
| Organization Name | BUSHNELL DIX HILL JONES 694110 |
| Other Organization Name | JACKSONVILLE DEVELOPMENTAL CENTER |
| Practice Address |
1201 S Main St Jacksonville IL 62650-3339 |
| Practice Telephone | 2174792120 |
| Practice Fax Number | 2172438920 |
| Mailing Telephone | 2174792120 |
| Mailing Fax Number | 2172438920 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SUSIE PENNELL (ADMINISTRATIVE ASST) |
| Authorized Official Telephone | 2174792120 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 694110 | 05 |
| Other Name | Type Code |
|---|---|
| Jacksonville Developmental Center | Doing Business As Name - Organization |
| Street Address |
1201 S MAIN ST |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-3339 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376753335 | Wayne E Petereit | Physical Therapist | 1201 S Main St, Jacksonville, IL 62650-3339 | 2007-05-22 |
| 1881738979 | Gillespie 694140 | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1201 S Main St, Jacksonville, IL 62650-3339 | 2007-02-20 |
| 1659441285 | Department of Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1201 S Main St, Jacksonville, IL 62650-3339 | 2006-11-09 |
| 1477632537 | Daniel Aguilar Manuat | Radiology | 1201 S Main St, Jacksonville, IL 62650-3339 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184932956 | L'arche Harbor House, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 700 Arlington Rd N, Jacksonville, FL 32211-7306 | 2010-09-15 |
| 1649426065 | Marjorie G. Cupp | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1545 Parkwood St, Jacksonville, FL 32207-5476 | 2008-08-18 |
| 1447382387 | Houseofdavid | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 209 Toni Dr, Jacksonville, NC 28546-4803 | 2007-03-09 |
| 1528198892 | Hampton Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 100 Cypress Ct, Jacksonville, NC 28540-4029 | 2007-03-06 |
| 1497882195 | Genesis Therapeutic Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 99 Village Dr Ste 12, Jacksonville, NC 28546-7060 | 2007-02-28 |
| 1831224849 | Irving Family Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 112 Lance Ct, Jacksonville, NC 28546-8640 | 2007-02-22 |
| 1639204233 | Moore Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 232 Newport Dr, Jacksonville, NC 28540-4005 | 2007-02-22 |
| 1720141542 | National Mentor Healthcare,llc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3615 Hodges Blvd, Jacksonville, FL 32224-1288 | 2006-12-19 |
| 1760971923 | Latrena M Thomas | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 14091 Summer Breeze Dr E, Jacksonville, FL 32218-8913 | 2018-05-03 |
| 1265693584 | Linda Elizabeth Gibson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 180 Coastal Ln, Jacksonville, NC 28546-6761 | 2008-06-19 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on BUSHNELL DIX HILL JONES 694110.
| 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.