NPIMap

Organization Active NPI

West Lake Residential - Building 220

  • Mental Illness Community Based Residential Treatment Facility
  • Springfield, IL
National Provider Identifier
1104071125
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
WEST LAKE RESIDENTIAL - BUILDING 220
Practice address
200 W Lake Dr
Building 220
Springfield, IL 62703-4956
Phone
(217) 588-7934
Fax
(217) 529-9803
NPI assigned
Nov 18, 2008
Organization subpart
Yes
Parent organization
MENTAL HEALTH CENTERS OF CENTRAL ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Ann Bowling
Title
Director
Phone
(217) 588-2626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X IL Primary

Addresses

Primary practice location

200 W Lake Dr
Building 220
Springfield, IL 62703-4956

Mailing address

200 W Lake Dr BLDG 220
Springfield, IL 62703-4956
Phone (217) 588-7934

National Provider Directory

National Provider Directory
Tax ID family
Mental HLTH CTRS-Centra15 organizations share this tax ID, including this one
Part of
Mental HLTH CTRS-Centra

Other organizations with this tax ID 14

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

View all 14

Locations

200 W Lake Dr
Bldg 220
Springfield, IL 62703
Phone (217) 588-7934

NPI Registry JSON

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

{
    "created_epoch": "1226966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1104071125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W LAKE DR BLDG 220",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627034956",
            "telephone_number": "217-588-7934",
            "fax_number": "217-529-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W LAKE DR",
            "address_2": "BUILDING 220",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627034956",
            "telephone_number": "217-588-7934",
            "fax_number": "217-529-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST LAKE RESIDENTIAL - BUILDING 220",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS",
        "enumeration_date": "2008-11-18",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "BOWLING",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "217-588-2626"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.