Organization · Type 2 NPI

Illinois Department of Human Sevices

Intellectual Disabilities Intermediate Care Facility · Waukegan, IL

NPI number 1679639967 Active

Practice location

1401 W Dugdale Rd
Waukegan, IL 60085

Call (847) 249-0600 Map

Fax (847) 249-0967

Mailing address

3649 Whirlaway Dr
Northbrook, IL 60062

Specialties and licenses

Taxonomy	Code	License
Developmental Disabilities Clinic/Center	261QD1600X	036067892 (IL)
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	None listed

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

52 other providers at this address

Other intellectual disabilities intermediate care facility providers in Waukegan

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NPI record

NPI: 1679639967
Entity type: Organization (Type 2)
Issued: Dec 29, 2006
Last updated: Dec 22, 2016
Status: Active
Subpart: Yes of Illinois Department of Human Services

Other names

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Ann Kiley Developmental Center · other name

Authorized official

Debra Muhlstadt
Fiscal Administrator, Sodc Operatio
(815) 288-8335

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1679639967

Illinois Department of Human Sevices's National Provider Identifier is 1679639967, issued on Dec 29, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Waukegan, IL. The record was last updated on Dec 22, 2016.