Organization
DISABILITY SERVICES OF ILLINOIS NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REUBEN F GOODWIN SR. (EXECUTIVE DIRECTOR)
(708) 753-1670
Entity
Organization
Contact information
Practice address
286 E 16TH ST, CHICAGO HEIGHTS, IL 60411-3730
(708) 753-1670
(708) 753-1679
Mailing address
PO BOX 351, MATTESON, IL 60443-0351
(708) 753-1670
(708) 753-1679
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/05/2016
Last updated
01/05/2016
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