Provider Demographics
NPI:1740604412
Name:HORIZON HOUSE OF ILLINOIS VALLEY
Entity Type:Organization
Organization Name:HORIZON HOUSE OF ILLINOIS VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERASTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-223-4488
Mailing Address - Street 1:2000 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1659
Mailing Address - Country:US
Mailing Address - Phone:815-223-4488
Mailing Address - Fax:815-223-5530
Practice Address - Street 1:2000 PLANK RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1659
Practice Address - Country:US
Practice Address - Phone:815-223-4488
Practice Address - Fax:815-223-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No347B00000XTransportation ServicesBus