NPI 1003960394

Illinois Department of Human Services

Organisation Intellectual Disabilities Intermediate Care Facility Centralia, IL

Practice location

Address: 1535 W McCord St, Centralia, IL 62801-5805
Phone: (618) 532-1811

Authorised official

Name: Debra Muhlstadt
Title: Fiscal Administrator, Sodc Operatio
Phone: (815) 288-8335

Registered specialties (2)

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X

Other Intermediate Care Facility, Intellectual Disabilities providers in Illinois →

Intellectual and/or Developmental Disabilities Residential Treatment Facility

Residential Treatment Facilities Taxonomy 320600000X Licence 805-8000 (IL)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Illinois →

Registry record

NPI: 1003960394
Entity type: Organization
NPI issued: 23 Jan 2007
Record last updated: 22 Dec 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.