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Organization
JACK MABLEY DEVELOPMENTAL CENTER
Active
Organization
JACK MABLEY DEVELOPMENTAL CENTER
Active
Other names
Johnson Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARON DEBERRY (CENTER DIRECTOR)
(815) 288-8330
Entity
Organization
Contact information
Practice address
1120 WASHINGTON AVE, DIXON, IL 61021-1258
(815) 288-8331
(815) 288-7275
Mailing address
1120 WASHINGTON AVE, DIXON, IL 61021-1258
(815) 288-8331
(815) 288-7275
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376525204
CENTER NPI NUMBER
IL
Enumeration date
02/21/2007
Last updated
07/21/2022
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