Provider Demographics
NPI:1952775058
Name:SPRINGFIELD DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:SPRINGFIELD DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-525-8271
Mailing Address - Street 1:4595 LAVERNA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-9732
Mailing Address - Country:US
Mailing Address - Phone:217-525-8271
Mailing Address - Fax:217-525-5801
Practice Address - Street 1:4595 LAVERNA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62707-9732
Practice Address - Country:US
Practice Address - Phone:217-525-8271
Practice Address - Fax:217-525-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services