Healthcare Provider Details

I. General information

NPI: 1104290204
Provider Name (Legal Business Name): DEVELOPMENTAL FOUNDATIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 BELMONT PT
CHAMPAIGN IL
61822-3506
US

IV. Provider business mailing address

4102 BELMONT PT
CHAMPAIGN IL
61822-3506
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-0754
  • Fax: 217-398-1535
Mailing address:
  • Phone: 217-398-0754
  • Fax: 217-398-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. SHERRY S NEWTON
Title or Position: CEO/PRESIDENT
Credential: MSW LCSW
Phone: 217-398-0754