Jack Mabley Dvelopmental Center in Dixon - Residential Treatment Facility, Intellectual And/or Developmental Disabilities
Jack Mabley Dvelopmental Center - NPI 1104961820
Jack Mabley Dvelopmental Center is a Residential Treatment Facility, Intellectual And/or Developmental Disabilities in Dixon, Illinois. Jack Mabley Dvelopmental Center practices all healthcare services and medical treatments related to Residential Treatment Facility, Intellectual And/or Developmental Disabilities. The NPI Number for Jack Mabley Dvelopmental Center is 1104961820. The last update date is 2022-07-21.
Jack Mabley Dvelopmental Center's current location address is 1120 Washington Ave, Dixon, Illinois. You can contact this provider via phone number 8152888331 and fax number 8152887275. The mailing address for Jack Mabley Dvelopmental Center is 1120 Washington Ave, Dixon, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Jack Mabley Dvelopmental Center |
|---|---|
| Address | 1120 Washington Ave, Dixon, Illinois |
| Phone Number | 8152888331 |
| Fax Number | 8152887275 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | CENTER DIR |
|---|---|
| Authorized Official Name | Deberry Sharon |
| Telephone Number | 8152888330 |
NPI Number Detail
| NPI Number | 1104961820 |
|---|---|
| Provider Enumeration Date | 2007-02-20 |
| Last Updated Date | 2022-07-21 |
Provider Mailing Address Detail
| Address | 1120 Washington Ave |
|---|---|
| City | Dixon |
| State | Illinois (IL) |
| Post Code | 610211258 |
| Phone Number | 8152888331 |
| Fax Number | 8152887275 |
Provider's Primary Taxonomy Detail
| Speciality | Residential Treatment Facility, Intellectual And/or Developmental Disabilities |
|---|---|
| Taxonomy | 320600000X |
|
Definition: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1376525204 | IL | CENTER NPI NUMBER |
Post Comment/ Review Below
What is the unique 10-digit identification code issued to Jack Mabley Dvelopmental Center by the Centers for Medicare & Medicaid Services?
The Jack Mabley Dvelopmental Center has been assigned the NPI (National Provider Identifier) 1104961820 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you provide the complete physical address where Jack Mabley Dvelopmental Center is located?
The Jack Mabley Dvelopmental Center is situated at the following address: 1120 Washington Ave, Dixon, IL, 610211258.
What is Jack Mabley Dvelopmental Center's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Jack Mabley Dvelopmental Center is Residential Treatment Facility, Intellectual And/or Developmental Disabilities, and the taxonomy classification code that categorizes this area of expertise is 320600000X.
On what date did the Jack Mabley Dvelopmental Center receive its 1104961820 assignment from the Centers for Medicare & Medicaid Services?
The Jack Mabley Dvelopmental Center was assigned its 1104961820 by the Centers for Medicare & Medicaid Services on 2007-02-20.
As of what date were the details related to Jack Mabley Dvelopmental Center most recently updated or revised?
The information pertaining to Jack Mabley Dvelopmental Center, including its address, specialty, and other relevant details, was last updated or revised on 2022-07-21.
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