KREIDER SERVICES INC NPI 1295067247

NPI Information

NPI: 1295067247
Provider Name: KREIDER SERVICES INC

Other Name: OTTAWA GROUP HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

Address:
726 N OTTAWA AVE
DIXON, IL
ZIP 61021
Phone: (815) 288-7397
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KREIDER SERVICES INC is an intermediate care facility mentally retarded in Dixon, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. KREIDER SERVICES INC NPI is 1295067247. The provider is registered as an organization entity type.
The provider Other Name Is Ottawa Group Home.

The provider's business location address is:

726 N OTTAWA AVE
DIXON, IL
ZIP 61021-632
Phone: (815) 288-7397

The provider's authorized official is Jeffrey J Stauter .
The authorized official title is Executive Director and has the following contact phone number (815) 288-6691.

The CLIA number assigned to this NPI record is 14D1048026 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/2/2010 and was last updated on 7/26/2016.

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		39065	ILLINOIS	Yes

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

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