Healthcare Provider Details

I. General information

NPI: 1740604412
Provider Name (Legal Business Name): HORIZON HOUSE OF ILLINOIS VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PLANK RD
PERU IL
61354-1659
US

IV. Provider business mailing address

2000 PLANK RD
PERU IL
61354-1659
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-4488
  • Fax: 815-223-5530
Mailing address:
  • Phone: 815-223-4488
  • Fax: 815-223-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM MONTERASTELLI
Title or Position: CEO
Credential:
Phone: 815-223-4488