Organization
ILLINOIS DEPARTMENT OF HUMAN SEVICES
Active
Parent organization
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Other names
Ann Kiley Developmental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
ILLINOIS DEPARTMENT OF HUMAN SERVICES
Authorized official
DEBRA MUHLSTADT (FISCAL ADMINISTRATOR, SODC OPERATIO)
(815) 288-8335
Entity
Organization
Contact information
Practice address
1401 W DUGDALE RD, WAUKEGAN, IL 60085
(847) 249-0600
(847) 249-0967
Mailing address
3649 WHIRLAWAY DR, NORTHBROOK, IL 60062
(847) 509-1254
(847) 509-1255
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
036067892
IL
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
12/29/2006
Last updated
12/22/2016
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