Illinois Department of Human Services

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

ILLINOIS DEPARTMENT OF HUMAN SERVICES

Practice address

114 N Orchard Dr
Park Forest, IL 60466-1200

Phone

(708) 283-3000

Fax

(708) 283-3020

NPI assigned

Apr 12, 2007

Organization subpart

No

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 1

Addresses

Other identifiers 1

Other names 1

• Elisabeth Ludeman Developmental Center Other name

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1053535864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 N ORCHARD DR",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661200",
            "telephone_number": "708-283-3000",
            "fax_number": "708-283-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 N ORCHARD DR",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661200",
            "telephone_number": "708-283-3000",
            "fax_number": "708-283-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "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": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000950111001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elisabeth Ludeman Developmental Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carol Lynn Holmes, LCSW
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• Intellectual Disabilities Intermediate Care Facility in Park Forest, IL
• Providers in Park Forest, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.