Hickory Street Place

LBN: Autumn Leaves, Inc.
Hickory Street Place is an health care organization with primary practice located at 3905 E. Hickory St. , Decatur IL 62521. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, which is considered as the primary health care specialty. Autumn Leaves, Inc. can be contacted via phone (217) 429-8231, or through Jacobus, David Michael via phone (217) 763-2191.

Contact Information

Primary practice address
3905 E. Hickory St. Decatur IL 62521
Phone: (217) 429-8231
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Jacobus, David Michael
Phone: (217) 763-2191

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X 37846 Illinois

Profile Details

NPI number 1891824892
LBN Legal business name Autumn Leaves, Inc.
DBA Doing business as Hickory Street Place
Authorized official Jacobus, David Michael
Entity Organization
Organization subpart 1 Yes
Enumeration date Mar 5th, 2007
Last updated Jan 23rd, 2017 - about 7 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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