Jacksonville Developmental Center

LBN: Gillespie 694140
Jacksonville Developmental Center is an health care organization with primary practice located at 1201 S Main St , Jacksonville IL 62650-3339. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as the primary health care specialty. Gillespie 694140 can be contacted via phone (217) 479-2120, or through Pennell, Susie via phone (217) 479-2120.

Contact Information

Primary practice address
1201 S Main St Jacksonville IL 62650-3339
Phone: (217) 479-2120
Fax: (217) 243-8920
Website:
Map and Directions
Authorized official contact:
Name: Pennell, Susie
Phone: (217) 479-2120

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X

Profile Details

NPI number 1881738979
LBN Legal business name Gillespie 694140
DBA Doing business as Jacksonville Developmental Center
Authorized official Pennell, Susie
Entity Organization
Organization subpart 1 No
Enumeration date Feb 20th, 2007
Last updated Aug 22nd, 2020 - about 5 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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Identifiers

StateTypeNumberIssuer
All States NPI 1881738979 NPPES
Illinois MEDICAID 694140

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