Provider Demographics
NPI:1447394325
Name:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Other - Org Name:MURRAY DEVELOPMENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-532-1811
Mailing Address - Street 1:1535 W MCCORD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-5805
Mailing Address - Country:US
Mailing Address - Phone:618-532-1811
Mailing Address - Fax:618-532-7464
Practice Address - Street 1:1535 W MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-5805
Practice Address - Country:US
Practice Address - Phone:618-532-1811
Practice Address - Fax:618-532-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL805-8000320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-G053Medicaid
IL000584064001Medicaid
IL14-G053Medicaid