NPIMap

Organization Active NPI

Elisabeth Ludeman Center

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Park Forest, IL
National Provider Identifier
1992841480
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
ELISABETH LUDEMAN CENTER
Practice address
114 N Orchard Dr
Park Forest, IL 60466-1200
Phone
(708) 283-3018
Fax
(708) 283-3020
NPI assigned
Jan 30, 2007
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
Ms. Jacquelyn Amelse, HIM
Title
Health Information Manager
Phone
(708) 283-3018

Specialties & licenses 1

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

Addresses

Primary practice location

114 N Orchard Dr
Park Forest, IL 60466-1200

Mailing address

114 N Orchard Dr
Park Forest, IL 60466-1200
Phone (708) 283-3018

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 4264292 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992841480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 N ORCHARD DR",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661200",
            "telephone_number": "708-283-3018",
            "fax_number": "708-283-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 N ORCHARD DR",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661200",
            "telephone_number": "708-283-3018",
            "fax_number": "708-283-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELISABETH LUDEMAN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AMELSE",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_title_or_position": "HEALTH INFORMATION MANAGER",
        "authorized_official_telephone_number": "708-283-3018",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "HIM"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Forest, 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.