Provider Demographics
NPI:1568775138
Name:DEVELOPMENTAL PLANNING & SERVICES INC
Entity Type:Organization
Organization Name:DEVELOPMENTAL PLANNING & SERVICES INC
Other - Org Name:RESERVOIR MANOR
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:
Practice Address - Street 1:419 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1600
Practice Address - Country:US
Practice Address - Phone:217-774-9544
Practice Address - Fax:217-774-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0051060315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0051060OtherDEPARTMENT OF PUBLIC HEALTH
IL14G082OtherPROVIDER IDENTIFICATION NUMBER
6007835OtherFACILITY ID
IL=========006Medicaid