Provider Demographics
NPI:1598908493
Name:ASSOCIATION FOR THE BETTERMENT OF RETARDED ADULTS
Entity Type:Organization
Organization Name:ASSOCIATION FOR THE BETTERMENT OF RETARDED ADULTS
Other - Org Name:ABRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-429-3007
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IL
Mailing Address - Zip Code:60966-0517
Mailing Address - Country:US
Mailing Address - Phone:815-429-3007
Mailing Address - Fax:815-429-1002
Practice Address - Street 1:107 N FOURTH STREET
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IL
Practice Address - Zip Code:60966
Practice Address - Country:US
Practice Address - Phone:815-429-3007
Practice Address - Fax:815-429-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL93S196320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities