NPIMap

Organization Active NPI

Arrowhead Ranch Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Coal Valley, IL
National Provider Identifier
1942621768
Registry record updated Dec 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
001583-11 Issued in IL
Legal business name
ARROWHEAD RANCH INC.
Practice address
12228 104TH St
Coal Valley, IL 61240-9712
Phone
(309) 799-7044
Fax
(309) 799-7090
NPI assigned
Dec 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2013

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

Authorized official

Name
Ms. Angela Moody, LCSW
Title
Ceo
Phone
(309) 799-7044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 001583-11 IL Primary

Addresses

Primary practice location

12228 104TH St
Coal Valley, IL 61240-9712

Mailing address

12228 104TH St
P.O. Box 370
Coal Valley, IL 61240-9712
Phone (309) 799-7044

National Provider Directory

National Provider Directory
Tax ID family
Arrowhead Ranch3 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": "1387497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387497600000",
    "number": "1942621768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12228 104TH ST",
            "address_2": "P.O. BOX 370",
            "city": "COAL VALLEY",
            "state": "IL",
            "postal_code": "612409712",
            "telephone_number": "309-799-7044",
            "fax_number": "309-799-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12228 104TH ST",
            "city": "COAL VALLEY",
            "state": "IL",
            "postal_code": "612409712",
            "telephone_number": "309-799-7044",
            "fax_number": "309-799-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARROWHEAD RANCH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-20",
        "last_updated": "2013-12-20",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-799-7044",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "IL",
            "license": "001583-11",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coal Valley, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; 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.