Organization
OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER, INC
Active
Other names
Sullivan House
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETH ANN MANGOLD (EXECUTIVE DIRECTOR)
(815) 434-0737
Entity
Organization
Contact information
Practice address
600 GROVER AVE, OTTAWA, IL 61350-4140
(815) 433-5858
Mailing address
1718 N 2525TH RD, OTTAWA, IL 61350-9329
(815) 434-0737
(815) 434-0493
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14G117
—
IL
Enumeration date
10/31/2014
Last updated
10/31/2014
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