MEDICARE: SPECIALIZED DEVELOPMENTS, LTD.

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	0041335	IL

General Provider Information

NPI Number	:	1629197074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED DEVELOPMENTS, LTD.

Provider Business Mailing Address
First Line	:	PO BOX 3275
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61826-3275
Country	:	US
Telephone Number	:	217-398-0754
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 BURNHAM DR
Second Line	:
City	:	UNIVERSITY PARK
State	:	IL
Zip	:	60466-2729
Country	:	US
Telephone Number	:	708-534-5821
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SHERRY S NEWTON
Credential	:
Telephone Number	:	217-398-0754

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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