Organization
KEMMERER VILLAGE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD LITTLE (EXECUTIVE DIRECTOR)
(217) 226-2116
Entity
Organization
Contact information
Practice address
941 N. 2500 EAST. RD., ASSUMPTION, IL 62510
(217) 226-4451
(217) 226-3511
Mailing address
941 N. 2500 EAST. RD., ASSUMPTION, IL 62510
(217) 226-4451
(217) 226-3511
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
0011289-10
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00112895116
DCFS CONTRACT NUMBER
IL
01
—
0112895113
RESIDENTIAL CONTRACT
—
05
—
3B00-IPI-041
—
IL
05
—
3B00IPI041
—
IL
Enumeration date
03/10/2006
Last updated
09/20/2018
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