NPIMap

Organization Active NPI

Ottawa Friendship House Work Activity Center, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Ottawa, IL
National Provider Identifier
1477958528
Registry record updated Oct 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC
Practice address
600 Grover Ave
Ottawa, IL 61350-4140
Phone
(815) 433-5858
NPI assigned
Oct 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2014

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

Authorized official

Name
Mrs. Beth Ann Mangold
Title
Executive Director
Phone
(815) 434-0737

Specialties & licenses 1

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

Addresses

Primary practice location

600 Grover Ave
Ottawa, IL 61350-4140

Mailing address

1718 N 2525TH Rd
Ottawa, IL 61350-9329
Phone (815) 434-0737

Other identifiers 1

IdentifierTypeStateIssuer
14G117MedicaidIL

Other names 1

  • Sullivan House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Glenwood House3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1414713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414713600000",
    "number": "1477958528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 N 2525TH RD",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613509329",
            "telephone_number": "815-434-0737",
            "fax_number": "815-434-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GROVER AVE",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613504140",
            "telephone_number": "815-433-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-31",
        "last_updated": "2014-10-31",
        "status": "A",
        "authorized_official_last_name": "MANGOLD",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-434-0737",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G117",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; 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.