Organization · Type 2 NPI

Illinois Department of Human Services

Intellectual Disabilities Intermediate Care Facility · Centralia, IL

NPI number 1003960394 Active

Practice location

1535 W Mccord St
Centralia, IL 62801-5805

Call (618) 532-1811 Map

Specialties and licenses

TaxonomyCodeLicense
Intellectual Disabilities Intermediate Care Facility Primary 315P00000XNone listed
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X805-8000 (IL)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

13 other providers at this address

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About NPI 1003960394

Illinois Department of Human Services's National Provider Identifier is 1003960394, issued on Jan 23, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Centralia, IL. The record was last updated on Dec 22, 2016.