Organization
BUSHNELL DIX HILL JONES 694110
Active
Other names
Jacksonville Developmental Center
Organization subpart
No
Provider details
NPI number
Authorized official
SUSIE PENNELL (ADMINISTRATIVE ASST)
(217) 479-2120
Entity
Organization
Contact information
Practice address
1201 S MAIN ST, JACKSONVILLE, IL 62650-3339
(217) 479-2120
(217) 243-8920
Mailing address
1201 S MAIN ST, JACKSONVILLE, IL 62650-3339
(217) 479-2120
(217) 243-8920
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
694110
—
IL
Enumeration date
02/20/2007
Last updated
08/22/2020
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