Illinois Valley Brain Injury Clubhouse

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

ILLINOIS VALLEY BRAIN INJURY CLUBHOUSE

Practice address

509 E Broadway St
Streator, IL 61364-2304

Phone

(815) 672-3000

NPI assigned

Sep 5, 2025

Organization subpart

No

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

Authorized official

Name

Mrs. Tonya Carter

Title

Director

Phone

(815) 672-3000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1757030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757030400000",
    "number": "1124908561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 E BROADWAY ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642304",
            "telephone_number": "815-672-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 E BROADWAY ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642304",
            "telephone_number": "815-672-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS VALLEY BRAIN INJURY CLUBHOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-05",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "815-672-3000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia A Hess, NP
• Jodi Hiltabrand, CCC-SLP/L
• Tyler Joseph Hogan, DPT
• HSHS Medical Group Inc
• Brian M. Hughes, D.D.S.
• Illinois Valley Radiology
• Indra Pal MDSC
• Infinity-Meds LLP
• Mervin Tan Inot
• Deborah Ann Jackson, PTA

• All providers in Streator, IL
• Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; 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.