Provider Demographics
NPI:1114117231
Name:STREATOR UNLIMITED INC
Entity Type:Organization
Organization Name:STREATOR UNLIMITED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:815-673-5574
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:305 N STERLING ST
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2369
Mailing Address - Country:US
Mailing Address - Phone:815-673-5574
Mailing Address - Fax:815-673-1714
Practice Address - Street 1:305 N STERLING ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2369
Practice Address - Country:US
Practice Address - Phone:815-673-5574
Practice Address - Fax:815-673-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001251C00000X
IL0024265315P00000X
IL916062320900000X
IL002343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid