Provider Demographics
NPI:1194869040
Name:APOSTOLIC CHRISTIAN HOME FOR THE HANDICAPPED, INC.
Entity type:Organization
Organization Name:APOSTOLIC CHRISTIAN HOME FOR THE HANDICAPPED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOBLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-266-9781
Mailing Address - Street 1:2125 VETERANS RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9566
Mailing Address - Country:US
Mailing Address - Phone:309-266-9781
Mailing Address - Fax:309-266-9468
Practice Address - Street 1:2125 VETERANS RD
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-9566
Practice Address - Country:US
Practice Address - Phone:309-266-9781
Practice Address - Fax:309-266-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0016220315P00000X
IL0033712315P00000X
IL0039305315P00000X
IL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities