NPIMap

Organization Active NPI

Ottawa Friendship House Work Activity Center, Inc

Doing business as Glenwood House

  • Intellectual Disabilities Intermediate Care Facility
  • Streator, IL
National Provider Identifier
1093110066
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC
Doing business as
Glenwood House
Practice address
600 West 12TH Street
Streator, IL 61364
Phone
(815) 673-1182
Fax
(815) 673-3231
NPI assigned
Nov 3, 2014
Last updated
Nov 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Authorized official

Name
Mrs. Beth Ann Mangold
Title
Executive Director
Phone
(815) 434-0737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

600 West 12TH Street
Streator, IL 61364

Mailing address

1718 N 2525TH Rd
Ottawa, IL 61350-9329
Phone (815) 434-0737

Other identifiers 1

IdentifierTypeStateIssuer
14G282MedicaidIL

Other names 1

  • Glenwood House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Glenwood House3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1414972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1093110066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 N 2525TH RD",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613509329",
            "telephone_number": "815-434-0737",
            "fax_number": "815-434-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WEST 12TH STREET",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "61364",
            "telephone_number": "815-673-1182",
            "fax_number": "815-673-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-03",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "MANGOLD",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-434-0737",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G282",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenwood House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Streator, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; 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.