OrganizationActive
Supporting Community Independence
NPI 1023643772 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Bethalto, IL
Provider details
- NPI number
- 1023643772
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Elizabeth Sahuri, Ceo(618) 806-4344
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Profile Score
Established profile(64/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 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
1 Polo Grounds Ct
Bethalto, IL 62010-2623
Phone: (618) 806-4344
Street-level locationGet directions
Mailing address
1 Polo Grounds Ct
Bethalto, IL 62010-2623
Registry dates
- Enumerated
- 2020-03-03
- Last updated
- 2020-03-03
- Certified
- 2020-03-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.