NPIMap

Organization Active NPI

Willowglen Academy Illinois

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Freeport, IL
National Provider Identifier
1811449523
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 ILLINOIS
Practice address
701 W Lamm Rd
Freeport, IL 61032-9630
Phone
(815) 233-6162
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
Samantha Jo Cusimano
Title
Qidp
Phone
(815) 233-6162

Specialties & licenses 1

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

Locations

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

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": "1811449523",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-28",
        "last_updated": "2016-10-28",
        "status": "A",
        "authorized_official_last_name": "CUSIMANO",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "QIDP",
        "authorized_official_telephone_number": "815-233-6162"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "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.