NPIMap

Organization Active NPI

Willowglen Academy

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Freeport, IL
National Provider Identifier
1710439435
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
WILLOWGLEN ACADEMY
Practice address
701 W Lamm Rd
Freeport, IL 61032-9630
Phone
(815) 233-6162
Fax
(815) 233-6167
NPI assigned
Oct 28, 2016
Last updated
Oct 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

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

Authorized official

Name
Mr. Roland Emeka Aguocha, QIDPNPI 1184176448
Title
Clinician
Phone
(571) 251-3230

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

701 W Lamm Rd
Freeport, IL 61032-9630

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477612800000",
    "number": "1710439435",
    "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": "701 W LAMM RD",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610329630",
            "telephone_number": "815-233-6162",
            "fax_number": "815-233-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-28",
        "last_updated": "2016-10-28",
        "status": "A",
        "authorized_official_last_name": "AGUOCHA",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "EMEKA",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "571-251-3230",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "QIDP"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "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 Oct 28, 2016; 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.