Organization
DEVELOPMENTAL PLANNING & SERVICES INC
Active
Other names
RANDOLPH HOUSE
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS K HEADLEE (PRESIDENT)
(618) 244-7701
Entity
Organization
Contact information
Practice address
404 S 1ST ST, VANDALIA, IL 62471-2808
(618) 283-0689
(618) 283-0608
Mailing address
PO BOX 2369, MOUNT VERNON, IL 62864-0046
(618) 244-7701
(618) 244-7704
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0050229
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050229
STATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH
IL
01
—
14G115
PROVIDER IDENTIFICATION #
IL
01
—
6007017
FACILITY ID
IL
Enumeration date
11/14/2008
Last updated
11/17/2008
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