| Organization Name: | ILLINOIS DEPARTMENT OF HUMAN SERVICES |
| NPI Number: | 1083620827 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANITA BAZILE (FACILITY ADMINISTRATOR) |
| Mailing Address: | 4500 College Ave Alton |
| State: | IL US |
| Postal Code: | 620025051 |
| Phone Number: | 6184743800 |
| Fax Number: | |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 10/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 283Q00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | Psychiatric Hospital |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |