ILLINOIS DEPARTMENT OF HUMAN SEVICES NPI 1679639967

NPI Information

NPI: 1679639967
Provider Name: ILLINOIS DEPARTMENT OF HUMAN SEVICES

Other Name: ANN KILEY DEVELOPMENTAL CENTER

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

Address:
1401 W DUGDALE RD
WAUKEGAN, IL
ZIP 60085
Phone: (847) 249-0600
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ILLINOIS DEPARTMENT OF HUMAN SEVICES is an intermediate care facility mentally retarded in Waukegan, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. ILLINOIS DEPARTMENT OF HUMAN SEVICES NPI is 1679639967. The provider is registered as an organization entity type.
The provider Other Name Is Ann Kiley Developmental Center.

The provider's business location address is:

1401 W DUGDALE RD
WAUKEGAN, IL
ZIP 60085
Phone: (847) 249-0600
Fax: (847) 249-0967

The provider's authorized official is Debra Muhlstadt .
The authorized official title is Fiscal Administrator, Sodc Operatio and has the following contact phone number (815) 288-8335.

The CLIA number assigned to this NPI record is 14D2249050 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/29/2006 and was last updated on 12/22/2016.

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	261QD1600X	Clinic/Center	Developmental Disabilities	036067892	ILLINOIS	No
2	315P00000X	Intermediate Care Facility, Intellectual Disabilities				Yes

What is NPI?

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

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