MULBERRY MANOR, INC.
NPI 1164646550
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Anna, IL

Active since April 13, 2007CLIA 14D0436466 · Waiver

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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

NPI1164646550
Entity TypeOrganization
Primary Taxonomy320600000X
Legal Business NameMULBERRY MANOR, INC.
Location Address612 E DAVIEAnna, IL 62906-0088
Mailing AddressPo Box 88Anna, IL 62906-0088 · (618) 833-6012
Organization SubpartNo
Authorized OfficialJoann KellerAdministrator · (618) 833-6012
Enumeration DateApril 13, 2007
Last NPPES UpdateAugust 22, 2020
NPI 1164646550 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320600000X
Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

612 E DAVIE, Anna, IL 62906

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, IL
Active · expires Aug 31, 2026
CLIA Number14D0436466
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorAmber Fairless
Laboratory Phone(618) 833-6012
Laboratory LocationMulberry Manor Inc612 E Davie St, Anna, IL 62906
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently 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 with the weekly NPPES data releases published by CMS.