NPIMap

Organization Active NPI

Willowglen Academy-Il

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Freeport, IL
National Provider Identifier
1386848299
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
411197-03 Issued in IL
Legal business name
WILLOWGLEN ACADEMY-IL
Practice address
3111 W Kunkle Blvd
Freeport, IL 61032-6922
Phone
(815) 233-0406
NPI assigned
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Elizabeth A Kinard
Title
Executive Director
Phone
(815) 233-6162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 411197-03 IL Primary

Addresses

Primary practice location

3111 W Kunkle Blvd
Freeport, IL 61032-6922

Mailing address

701 W Lamm Rd
Freeport, IL 61032-9630
Phone (815) 233-6162

National Provider Directory

National Provider Directory
Tax ID family
Broadstep Academy-Illinois Inc39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

3111 W Kunkle Blvd
Freeport, IL 61032
Phone (815) 233-0406

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386848299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W LAMM RD",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610329630",
            "telephone_number": "815-233-6162",
            "fax_number": "815-233-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 W KUNKLE BLVD",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326922",
            "telephone_number": "815-233-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY-IL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KINARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-233-6162",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "411197-03",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.