Provider Demographics
NPI:1710053046
Name:MILESTONE, INC.
Entity Type:Organization
Organization Name:MILESTONE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-639-2817
Mailing Address - Street 1:4060 MCFARLAND RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4402
Mailing Address - Country:US
Mailing Address - Phone:815-654-6100
Mailing Address - Fax:815-654-6444
Practice Address - Street 1:4060 MCFARLAND RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4402
Practice Address - Country:US
Practice Address - Phone:815-654-6100
Practice Address - Fax:815-654-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213223Medicare ID - Type Unspecified