Provider Demographics
NPI:1063666279
Name:DEVELOPMENTAL PLANNING & SERVICES INC
Entity Type:Organization
Organization Name:DEVELOPMENTAL PLANNING & SERVICES INC
Other - Org Name:RANDOLPH HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:HEADLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-244-7701
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0046
Mailing Address - Country:US
Mailing Address - Phone:618-244-7701
Mailing Address - Fax:618-244-7704
Practice Address - Street 1:404 S 1ST ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-2808
Practice Address - Country:US
Practice Address - Phone:618-283-0689
Practice Address - Fax:618-283-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0050229315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6007017OtherFACILITY ID
IL0050229OtherSTATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH
IL14G115OtherPROVIDER IDENTIFICATION #