Healthcare Provider Details

I. General information

NPI: 1538277637
Provider Name (Legal Business Name): ILLINOIS DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N MAIN ST
ANNA IL
62906-1652
US

IV. Provider business mailing address

1000 N MAIN ST
ANNA IL
62906-1652
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-5161
  • Fax:
Mailing address:
  • Phone: 618-833-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHERYL MUCKLEY
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 618-833-5161