Healthcare Provider Details

I. General information

NPI: 1144350802
Provider Name (Legal Business Name): IDHS-MCFARLAND MHC-JEFFERSON HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SOUTHWIND DR
SPRINGFIELD IL
62703-5125
US

IV. Provider business mailing address

901 SOUTHWIND DR
SPRINGFIELD IL
62703-5125
US

V. Phone/Fax

Practice location:
  • Phone: 217-786-6994
  • Fax:
Mailing address:
  • Phone: 217-786-6994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. DEBBIE DILELLO
Title or Position: QUALITY MANAGER
Credential:
Phone: 217-786-6994