Provider Demographics
NPI:1891994893
Name:DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF HUMAN SERVICES
Other - Org Name:CENTRAL OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE II
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-785-8741
Mailing Address - Street 1:100 S GRAND AVE E
Mailing Address - Street 2:FEDERAL REPORTING UNIT
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3802
Mailing Address - Country:US
Mailing Address - Phone:217-785-8741
Mailing Address - Fax:
Practice Address - Street 1:100 S GRAND AVE E
Practice Address - Street 2:FEDERAL REPORTING UNIT
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3802
Practice Address - Country:US
Practice Address - Phone:217-785-8741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities