MULBERRY MANOR, INC.
NPI 1164646550
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Anna, IL
About Mulberry Manor, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MULBERRY MANOR, INC. (NPI 1164646550) is a healthcare organization registered as a residential treatment facility, intellectual and/or developmental disabilities in Anna, Illinois and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Joann Keller, Administrator, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 14D0436466
Mulberry Manor Inc · Anna, ILFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mulberry Manor, Inc.'s NPI number?
The NPI number for Mulberry Manor, Inc. is 1164646550. It was assigned to this organization in the NPPES registry on April 13, 2007.
Where is Mulberry Manor, Inc. located?
Mulberry Manor, Inc. is located at 612 E Davie, Anna, IL 62906. The listed phone number is (618) 833-6012.
What is Mulberry Manor, Inc.'s specialty?
The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.
Does Mulberry Manor, Inc. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D0436466) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Mulberry Manor, Inc. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mulberry Manor, Inc. · NPI 1164646550
Residential Treatment Facility, Intellectual and/or Developmental Disabilities organization in Anna, Illinois. Organization record, active in the CMS NPPES registry since April 13, 2007.
## Identity
- **NPI:** 1164646550 (Entity type: Organization)
- **Enumerated:** April 13, 2007
- **Primary specialty:** Residential Treatment Facility, Intellectual and/or Developmental Disabilities · taxonomy 320600000X
- **Organization subpart:** No
- **Authorized official:** Joann Keller, ADMINISTRATOR
## Practice location
- **Address:** 612 E DAVIE, Anna, IL 62906-0088
- **Phone:** (618) 833-6012
## Record status
- **NPPES last updated:** August 22, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1164646550) · Data from the CMS NPPES public registry.