Provider Demographics
NPI:1457575243
Name:DEVELOPMENTAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:DEVELOPMENTAL MANAGEMENT, INC.
Other - Org Name:COLONIAL PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-327-9846
Mailing Address - Street 1:15755 NIXON RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-4815
Mailing Address - Country:US
Mailing Address - Phone:618-327-9846
Mailing Address - Fax:618-327-9845
Practice Address - Street 1:618 W GOODNER ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1009
Practice Address - Country:US
Practice Address - Phone:618-327-3911
Practice Address - Fax:618-327-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039552313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001OtherIDPH PROVIDER NUMBER