OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER INC NPI 1093110066

NPI Information

NPI: 1093110066
Provider Name: OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC

Doing Business As: GLENWOOD HOUSE

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
600 WEST 12TH STREET
STREATOR, IL
ZIP 61364
Phone: (815) 673-1182
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OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC is an intermediate care facility mentally retarded in Streator, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC NPI is 1093110066. The provider is registered as an organization entity type.
The provider Is Doing Business As Glenwood House.

The provider's business location address is:

600 WEST 12TH STREET
STREATOR, IL
ZIP 61364
Phone: (815) 673-1182
Fax: (815) 673-3231

The provider's authorized official is Beth Ann Mangold .
The authorized official title is Executive Director and has the following contact phone number (815) 434-0737.

The enumeration date for this NPI number is 11/3/2014 and was last updated on 11/3/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	14G282	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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