Provider Demographics
NPI:1225086770
Name:MOTIVATING INDIVIDUALS FOR LEARNING AND LIVING
Entity Type:Organization
Organization Name:MOTIVATING INDIVIDUALS FOR LEARNING AND LIVING
Other - Org Name:THE MILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPRUYT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-282-7741
Mailing Address - Street 1:3445 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-9529
Mailing Address - Country:US
Mailing Address - Phone:815-282-7741
Mailing Address - Fax:815-636-5041
Practice Address - Street 1:3445 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-9529
Practice Address - Country:US
Practice Address - Phone:815-282-7741
Practice Address - Fax:815-636-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL401288-04322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2B05-CHR-042Medicaid
IL=========001OtherDPA