NPIMap

Organization Active NPI

Kreider Services Incorporated

  • Intellectual Disabilities Intermediate Care Facility
  • Amboy, IL
National Provider Identifier
1265762355
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
40188 Issued in IL
Legal business name
KREIDER SERVICES INCORPORATED
Practice address
110 S Boyd Ave
Amboy, IL 61310-1506
Phone
(815) 857-2299
NPI assigned
Jan 12, 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 40188 IL Primary

Addresses

Primary practice location

110 S Boyd Ave
Amboy, IL 61310-1506

Mailing address

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

Other names 1

  • Boyd Avenue 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 1265762355. Details of each certification follow.

  • CCN 14G310 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G310

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
BOYD AVENUE HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 1, 1993
Last certification
Jan 23, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
110 South Boyd Avenue
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": "1263254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1265762355",
    "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": "110 S BOYD AVE",
            "city": "AMBOY",
            "state": "IL",
            "postal_code": "613101506",
            "telephone_number": "815-857-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KREIDER SERVICES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-12",
        "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": "40188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boyd Avenue Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Amboy, IL

Sources for this page

Verify at the official NPI Registry.