NPIMap

Organization Active NPI

Unit 4464 Cypress Hall Upper

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Anna, IL
National Provider Identifier
1104958966
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
UNIT 4464 CYPRESS HALL UPPER
Practice address
1000 N Main St
Anna, IL 62906-1652
Phone
(618) 833-5161
NPI assigned
Mar 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Bruce Brown
Title
Reimbursement Officer II
Phone
(618) 833-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

1000 N Main St
Anna, IL 62906-1652

Mailing address

1000 N Main St
Anna, IL 62906-1652
Phone (618) 833-5161

Other identifiers 1

IdentifierTypeStateIssuer
14G045MedicaidIL

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 24

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

View all 24

Locations

1000 N Main St
Anna, IL 62906
Phone (618) 833-5161

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104958966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061652",
            "telephone_number": "618-833-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061652",
            "telephone_number": "618-833-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIT 4464 CYPRESS HALL UPPER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "REIMBURSEMENT OFFICER II",
        "authorized_official_telephone_number": "618-833-5161"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G045",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anna, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.