OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC (NPI# 1477958528) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477958528 |
| Entity Type | Organization |
| Organization Name | OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC |
| Other Organization Name | SULLIVAN HOUSE |
| Practice Address |
600 Grover Ave Ottawa IL 61350-4140 |
| Mailing Address |
1718 N 2525th Rd Ottawa IL 61350-9329 |
| Practice Telephone | 8154335858 |
| Mailing Telephone | 8154340737 |
| Mailing Fax Number | 8154340493 |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2014-10-31 |
| Authorized Official Name | MRS. BETH ANN MANGOLD (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8154340737 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 14G117 | 05 |
| Other Name | Type Code |
|---|---|
| Sullivan House | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093110066 | Ottawa Friendship House Work Activity Center, Inc | Intermediate Care Facility, Mentally Retarded | 600 West 12th Street, Streator, IL 61364 | 2014-11-03 |
| Street Address |
600 GROVER AVE |
| City | OTTAWA |
| State | IL |
| Zip Code | 61350-4140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487832903 | Sullivan House Residential Care, Inc. | Intermediate Care Facility, Mentally Retarded | 600 Grover Ave, Ottawa, IL 61350-4140 | 2008-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306336359 | Yulandist Jeannie Brown | Licensed Practical Nurse | 617 Columbus St, Ottawa, IL 61350 | 2018-05-15 |
| 1881071272 | Ashlee Herbold | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1718 N 2525th Rd, Ottawa, IL 61350 | 2015-05-05 |
| 1053702365 | Wanda Rohl | Social Worker | 3735 E 1453 Rd, Ottawa, IL 61350 | 2015-02-09 |
| 1538550868 | Erin Rose Boe | Physical Therapist | 2872 Columbus St, Unit 300, Ottawa, IL 61350 | 2015-02-09 |
| 1346572757 | Rebecca Samolitis | Counselor | 116 W Lafayette St, Suite 8, Ottawa, IL 61350 | 2010-02-10 |
| 1235383266 | Timothy I Miller O.d. P.C. | Optometrist | 107 E. Mckinley Rd., Ottawa, IL 61350 | 2008-11-04 |
| 1427204676 | Leo John Meagher | Counselor | 218 West Madison St, Ottawa, IL 61350 | 2008-08-07 |
| 1598938755 | Radiation Oncology of Northern Illinois LLC | Radiology | 1200 Starfire Dr, Ottawa, IL 61350 | 2008-04-09 |
| 1154538510 | Serenityonwheels, Inc. | Counselor | Serenity On Wheels, Inc. 630 Columbus Street, Ste # 214, Ottawa, IL 61350 | 2007-05-16 |
| 1205040904 | Dixie Devry | Occupational Therapist | 2532 Reynolds Manor, Ottawa, IL 61350 | 2007-05-10 |
| Find all providers in zip 61350 | ||||
| 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 |
|---|---|---|---|---|
| 1790957157 | Frances House Inc | Intermediate Care Facility, Mentally Retarded | 724 Second Avenue, Ottawa, IL 61350-4010 | 2008-03-26 |
| 1487832903 | Sullivan House Residential Care, Inc. | Intermediate Care Facility, Mentally Retarded | 600 Grover Ave, Ottawa, IL 61350-4140 | 2008-02-06 |
| 1164630802 | Voca Corp | Intermediate Care Facility, Mentally Retarded | 8076 Road 13g, Ottawa, OH 45875-8609 | 2007-05-18 |
| 1740497064 | Voca Corp | Intermediate Care Facility, Mentally Retarded | 8088 Road 13g, Ottawa, OH 45875-8609 | 2007-05-17 |
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|---|---|---|---|---|
| 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.