MEDICARE: DEVELOPMENTAL PLANNING & SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	0030866	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14G108	OTHER	IL	PROVIDER IDENTIFICATION #
2	0030866	OTHER	IL	LG TERM CARE ICF DD 16
3	6006803	OTHER	IL	FACILITY ID

General Provider Information

NPI Number	:	1669524401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL PLANNING & SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 2369
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-0046
Country	:	US
Telephone Number	:	618-244-7701
Fax Number	:	618-244-7704

Provider Business Practice Location Address
First Line	:	4219 LINCOLNSHIRE DR
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2157
Country	:	US
Telephone Number	:	618-242-2117
Fax Number	:	618-242-9770

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENNIS K HEADLEE
Credential	:
Telephone Number	:	618-244-7701

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	11/17/2008

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