NPIMap

Organization Active NPI

Illinois Department of Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
National Provider Identifier
1003960394
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Practice address
1535 W McCord St
Centralia, IL 62801-5805
Phone
(618) 532-1811
NPI assigned
Jan 23, 2007
Last updated
Dec 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 805-8000 IL

Addresses

Primary practice location

1535 W McCord St
Centralia, IL 62801-5805

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
14-G053MedicaidIL

Other names 1

  • Warren G. Murray Developmental Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031113000414 IL Part B Supplier - Clinic/Group Practice 9830003920 Receives reassigned benefits from 43 practitioners
16 other NPIs on this enrollment
Practice locations: Centralia, IL; Waukegan, IL; Park Forest, IL; Kankakee, IL; Hines, IL; Dwight, IL; Dixon, IL; Chicago, IL…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003960394. Details of each certification follow.

  • CCN 14G053 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G053

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WARREN G MURRAY DEV CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 19, 1979
Last certification
Oct 25, 2024
Beds
376
Ownership / control type
State
Facility address
1535 West McCord
Centralia, IL 62801

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Elisabeth Ludeman Center292 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Elgin Mental Health CenterElgin, IL, CCN 144037 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1975
Chicago Read Mental Health CenterChicago, IL, CCN 144010 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1970
Elizabeth Parsons Ware Packard Mental Health CenterSpringfield, IL, CCN 144021 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1975
Alton Mental Health CenterAlton, IL, CCN 144016 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 1, 1996
John J Madden Mental Health CenterHines, IL, CCN 144028 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1975

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 46

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1003960394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 W MCCORD ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628015805",
            "telephone_number": "618-532-1811",
            "fax_number": "618-532-7464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 W MCCORD ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628015805",
            "telephone_number": "618-532-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "MUHLSTADT",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "FISCAL ADMINISTRATOR, SODC OPERATIO",
        "authorized_official_telephone_number": "815-288-8335"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "805-8000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14-G053",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warren G. Murray Developmental Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Centralia, IL

Sources for this page

Verify at the official NPI Registry.