Organization
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Active
Other names
Warren G. Murray 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
1535 W MCCORD ST, CENTRALIA, IL 62801-5805
(618) 532-1811
Mailing address
1535 W MCCORD ST, CENTRALIA, IL 62801-5805
(618) 532-1811
(618) 532-7464
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
805-8000
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14-G053
—
IL
Enumeration date
01/23/2007
Last updated
12/22/2016
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