NPIMap

Organization Active NPI

Illinois Department of Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Kankakee, IL
National Provider Identifier
1821136821
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Practice address
100 E Jeffery St
Kankakee, IL 60901-5018
Phone
(815) 939-8201
Fax
(815) 939-8266
NPI assigned
Feb 2, 2007
Last updated
Dec 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Authorized official

Name
Debra Muhlstadt
Title
Fiscal Administrator, Sodc Operatio
Phone
(815) 288-8335

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X IL

Addresses

Primary practice location

100 E Jeffery St
Kankakee, IL 60901-5018

Mailing address

100 E Jeffery St
Kankakee, IL 60901-5018
Phone (815) 939-8201

Other names 1

  • Shapiro Development 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
Tax ID family
Howe Center - Unit 4267292 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 10

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": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1821136821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E JEFFERY ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609015018",
            "telephone_number": "815-939-8201",
            "fax_number": "815-939-8266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E JEFFERY ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609015018",
            "telephone_number": "815-939-8201",
            "fax_number": "815-939-8266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "MUHLSTADT",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "FISCAL ADMINISTRATOR, SODC OPERATIO",
        "authorized_official_telephone_number": "815-288-8335"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shapiro Development Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.