OrganizationActive
Illinois Department of Human Services
NPI 1003960394 · Intellectual Disabilities Intermediate Care Facility · Centralia, IL
Provider details
- NPI number
- 1003960394
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Debra Muhlstadt, Fiscal Administrator, Sodc Operatio(815) 288-8335
- License
- 805-8000 (IL)
Specialties & taxonomies
Nursing & Custodial Care Facilities
- Intellectual and/or Developmental Disabilities Residential Treatment Facility320600000XLicense 805-8000 (IL)
Residential Treatment Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1535 W Mccord St
Centralia, IL 62801-5805
Phone: (618) 532-1811
Street-level locationGet directions
Mailing address
1535 W Mccord St
Centralia, IL 62801-5805
Other names (DBA / former)
- Other name
- Warren G. Murray Developmental Center
Registry dates
- Enumerated
- 2007-01-23
- Last updated
- 2016-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.