OrganizationActive
Dhs
NPI 1356890453 · Physical Disabilities Residential Treatment Facility · Fairfield, IL
Provider details
- NPI number
- 1356890453
- Entity type
- Organization
- Primary specialty
- Physical Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Jennifer Weedman, Cna(618) 516-2920
- License
- 376K00000X (IL)
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Established profile(71/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 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
109 W Wilson St
Fairfield, IL 62837-1816
Phone: (618) 516-2920
Street-level locationGet directions
Mailing address
109 W Wilson St
Fairfield, IL 62837-1816
Registry dates
- Enumerated
- 2016-09-30
- Last updated
- 2016-09-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.