Organization Name: | JACK MABLEY DVELOPMENTAL CENTER |
NPI Number: | 1104961820 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHARON DEBERRY (CENTER DIRECTOR) |
Mailing Address: | 1120 Washington Ave Dixon |
State: | IL US |
Postal Code: | 610211258 |
Phone Number: | 8152888331 |
Fax Number: | 8152887275 |
NPI Enumeration Date: | 02/20/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | ========= |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |