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Organization
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Active
Organization
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Active
Other names
Choate Mental Health & Developmental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA MUHLSTADT (FISCAL ADMINISTRATOR, SODC OPERATIO)
(815) 288-8335
Entity
Organization
Contact information
Practice address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161
Mailing address
1000 N MAIN ST, ANNA, IL 62906-1652
(618) 833-5161
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G045
—
IL
Enumeration date
03/09/2007
Last updated
12/22/2016
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