NPIMap

Organization Active NPI

Department of Human Services

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Jacksonville, IL
National Provider Identifier
1659441285
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
DEPARTMENT OF HUMAN SERVICES
Practice address
1201 S Main St
Jacksonville, IL 62650-3339
Phone
(217) 479-2120
Fax
(217) 245-1165
NPI assigned
Nov 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Michael Hurt
Title
Center Director
Phone
(217) 479-2110

Specialties & licenses 1

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

Addresses

Primary practice location

1201 S Main St
Jacksonville, IL 62650-3339

Mailing address

1201 S Main St
Jacksonville, IL 62650-3339
Phone (217) 479-2120

Other names 1

  • JACKSONVILLE 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

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659441285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503339",
            "telephone_number": "217-479-2120",
            "fax_number": "217-245-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503339",
            "telephone_number": "217-479-2120",
            "fax_number": "217-245-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HURT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CENTER DIRECTOR",
        "authorized_official_telephone_number": "217-479-2110"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSONVILLE DEVELOPMENTAL CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jacksonville, 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.
  • 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.