Organization
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Active
Other names
Jack Mabley 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
1120 WASHINGTON AVE, DIXON, IL 61021-1258
(815) 288-8301
(815) 288-8398
Mailing address
1120 WASHINGTON AVE, DIXON, IL 61021-1258
(815) 288-8301
(815) 288-8398
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
830600
IL
Other
Enumeration date
11/16/2005
Last updated
12/22/2016
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