NPIMap

Organization Active NPI

Kreider Services Incorporated

  • Intellectual Disabilities Intermediate Care Facility
  • Amboy, IL
National Provider Identifier
1194057141
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
40196 Issued in IL
Legal business name
KREIDER SERVICES INCORPORATED
Practice address
317 W Division St
Amboy, IL 61310-1007
Phone
(815) 857-4105
NPI assigned
Feb 2, 2010
Last updated
Jul 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Authorized official

Name
Mr. Jeffrey J Stauter
Title
Executive Director
Phone
(815) 288-6691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 40196 IL Primary

Addresses

Primary practice location

317 W Division St
Amboy, IL 61310-1007

Mailing address

PO Box 366
Dixon, IL 61021-0366
Phone (815) 288-6691

Other names 1

  • Division Street Home Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194057141. Details of each certification follow.

  • CCN 14G306 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G306

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DIVISION STREET HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 1, 1993
Last certification
Feb 20, 2025
Beds
6
Ownership / control type
Private (non-profit)
Most recent change of ownership
Oct 25, 2006
Facility address
317 West Division Street
Amboy, IL 61310

National Provider Directory

National Provider Directory
Tax ID family
Kreider Services Inc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1194057141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610210366",
            "telephone_number": "815-288-6691",
            "fax_number": "815-288-1636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 W DIVISION ST",
            "city": "AMBOY",
            "state": "IL",
            "postal_code": "613101007",
            "telephone_number": "815-857-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KREIDER SERVICES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "STAUTER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-288-6691",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "40196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Division Street Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Amboy, IL

Sources for this page

Verify at the official NPI Registry.