NPI 1376525204

Illinois Department of Human Services

Organisation Intellectual Disabilities Intermediate Care Facility Dixon, IL

Practice location

Address: 1120 Washington Ave, Dixon, IL 61021-1258
Phone: (815) 288-8301
Fax: (815) 288-8398

Authorised official

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

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 830600 (IL)

Other Intermediate Care Facility, Intellectual Disabilities providers in Illinois →

Registry record

NPI: 1376525204
Entity type: Organization
NPI issued: 16 Nov 2005
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.