NPIMap

Organization Active NPI

Jack Mabley Developmental Center

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Dixon, IL
National Provider Identifier
1285779892
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
JACK MABLEY DEVELOPMENTAL CENTER
Practice address
1120 Washington Ave
Dixon, IL 61021-1258
Phone
(815) 288-8331
Fax
(815) 288-7275
NPI assigned
Feb 21, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Sharon Deberry
Title
Center Director
Phone
(815) 288-8330

Specialties & licenses 1

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

Addresses

Primary practice location

1120 Washington Ave
Dixon, IL 61021-1258

Mailing address

1120 Washington Ave
Dixon, IL 61021-1258
Phone (815) 288-8331

Other identifiers 1

IdentifierTypeStateIssuer
1376525204OtherILCENTER NPI NUMBER

Other names 1

  • Keller Home Other name

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

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1285779892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 WASHINGTON AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211258",
            "telephone_number": "815-288-8331",
            "fax_number": "815-288-7275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 WASHINGTON AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211258",
            "telephone_number": "815-288-8331",
            "fax_number": "815-288-7275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK MABLEY DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DEBERRY",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CENTER DIRECTOR",
        "authorized_official_telephone_number": "815-288-8330",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTER NPI NUMBER",
            "identifier": "1376525204",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keller Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dixon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.