Organization
KREIDER SERVICES INCORPORATED
Active
Other names
Division Street Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY J STAUTER (EXECUTIVE DIRECTOR)
(815) 288-6691
Entity
Organization
Contact information
Practice address
317 W DIVISION ST, AMBOY, IL 61310-1007
(815) 857-4105
Mailing address
PO BOX 366, DIXON, IL 61021-0366
(815) 288-6691
(815) 288-1636
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
40196
IL
Other
Enumeration date
02/02/2010
Last updated
07/26/2016
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