ILLINOIS DEPARTMENT OF HUMAN SERVICES (NPI# 1265584155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265584155 |
| Entity Type | Organization |
| Organization Name | ILLINOIS DEPARTMENT OF HUMAN SERVICES |
| Other Organization Name | WM. W. FOX DEVELOPMENTAL CENTER |
| Practice Address |
134 W Main St Dwight IL 60420-1322 |
| Practice Telephone | 8155843347 |
| Mailing Telephone | 8155843347 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2016-12-22 |
| Authorized Official Name | DEBRA MUHLSTADT (FISCAL ADMINISTRATOR, SODC OPERATIO) |
| Authorized Official Telephone | 8152888335 |
| Is Organization Subpart | Y |
| Parent Organization Name | ILLINOIS DEPARTMENT OF HUMAN SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | IL | Residential Treatment Facilities | |
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Wm. W. Fox 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 |
| 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 |
134 W MAIN ST |
| City | DWIGHT |
| State | IL |
| Zip Code | 60420-1322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932243920 | Wm. W. Fox Developmental Center 3a | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1972647808 | Wm. W. Fox Developmental Center 1b | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1811031818 | Wm. W. Fox Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1720122724 | Wm. W. Fox Developmental Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1639213630 | Wm. W. Fox Developmental Center 3c | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1063556066 | Wm. W. Fox Developmental Center 3b | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1710021696 | Wm. W. Fox Developmental Center 2c | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1629112503 | Wm. W. Fox Developmental Center 1c | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-16 |
| 1841330693 | Suresh Vade | Family Medicine | 134 W Main St, Dwight, IL 60420-1322 | 2007-02-08 |
| 1063566891 | Wm. W. Fox Developmental Center | Pharmacy | 134 W Main St, Dwight, IL 60420-1322 | 2007-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902149982 | Maulin G Shah | Family Medicine | 107 Watters Dr, Dwight, IL 60420 | 2013-03-28 |
| 1558446633 | Highland Park Cvs, L.l.c | Durable Medical Equipment & Medical Supplies | 106 Watters Dr, Dwight, IL 60420 | 2006-10-26 |
| 1861598997 | Cynthia Ann Humbert | Dentist | 413 E Mazon Ave, Dwight, IL 60420 | 2006-09-16 |
| 1851404313 | Mark A Passerman | Family Medicine | 101 S Prairie Ave, Dwight, IL 60420 | 2006-08-17 |
| 1528174489 | Bradford R Egly | Podiatrist | 108 W Main St, Dwight, IL 60420 | 2006-08-22 |
| 1558820829 | Laura E Lamere | Occupational Therapy Assistant | 215 E North St, Dwight, IL 60420-1051 | 2019-03-17 |
| 1982695029 | Heritage Manor Dwight, LLC | Durable Medical Equipment & Medical Supplies | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2005-10-28 |
| 1194280024 | Matthew J Govednik | Physical Therapy Assistant | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2019-02-05 |
| 1215346036 | Kelly Martin | Occupational Therapist | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2014-08-06 |
| 1487061974 | Debra Wilder | Physical Therapy Assistant | 300 E Mazon Ave, Dwight, IL 60420-1104 | 2014-07-16 |
| Find all providers in zip 60420 | ||||
| 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.