NPIMap

Organization Active NPI

Illinois Department of Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Dwight, IL
National Provider Identifier
1265584155
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Practice address
134 W Main St
Dwight, IL 60420-1322
Phone
(815) 584-3347
NPI assigned
Jan 18, 2007
Last updated
Dec 22, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
ILLINOIS DEPARTMENT OF HUMAN SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Authorized official

Name
Debra Muhlstadt
Title
Fiscal Administrator, Sodc Operatio
Phone
(815) 288-8335

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X IL

Addresses

Primary practice location

134 W Main St
Dwight, IL 60420-1322

Mailing address

134 W Main St
Dwight, IL 60420-1322
Phone (815) 584-3347

Other names 1

  • Wm. W. Fox Developmental Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031113000414 IL Part B Supplier - Clinic/Group Practice 9830003920 Receives reassigned benefits from 43 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centralia, IL; Waukegan, IL; Park Forest, IL; Kankakee, IL; Hines, IL; Dwight, IL; Dixon, IL; Chicago, IL…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Howe Center - Unit 4267292 organizations share this tax ID, including this one
Part of
Howe Center - Unit 4267

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

100 S Grand Ave E
Fl 1
Springfield, IL 62762

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1265584155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 W MAIN ST",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604201322",
            "telephone_number": "815-584-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 W MAIN ST",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604201322",
            "telephone_number": "815-584-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ILLINOIS DEPARTMENT OF HUMAN SERVICES",
        "enumeration_date": "2007-01-18",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "MUHLSTADT",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "FISCAL ADMINISTRATOR, SODC OPERATIO",
        "authorized_official_telephone_number": "815-288-8335"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wm. W. Fox Developmental Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dwight, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.