BEACON STREET PLACE
NPI 1306975594
Intermediate Care Facility, Intellectual Disabilities in Decatur, IL

Q: What is Autumn Leaves, Inc.'s NPI number?

The NPI number for Autumn Leaves, Inc. is 1306975594. It was assigned to this organization in the NPPES registry on March 5, 2007. The provider is doing business as Beacon Street Place.

Q: What is Autumn Leaves, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Active since March 05, 2007

4838 BEACON STREET, DECATUR, IL 62521(217) 422-1761(217) 422-1760 Get Directions Write a Review

NPPES record last updated: January 23, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Beacon Street Place NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BEACON STREET PLACE (NPI 1306975594) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Decatur, Illinois and active in the NPI registry since March 2007. The organization lists David Michael Jacobus, President, as its authorized official.

NPPES Registry Identity

NPI1306975594

Entity TypeOrganization

Primary Taxonomy315P00000X

Legal Business NameAUTUMN LEAVES, INC.

Location Address4838 BEACON STREETDecatur, IL 62521

Mailing Address2576 N Greenway RdCerro Gordo, IL 61818-3022 · (217) 763-2191 · Fax (217) 763-2101

Phone(217) 422-1761

Fax(217) 422-1760

Organization SubpartYesParent: Autumn Leaves, Inc

Authorized OfficialDavid Michael JacobusPresident · (217) 763-2191

Enumeration DateMarch 5, 2007

Last NPPES UpdateJanuary 23, 2017

✔ NPI 1306975594 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities

Taxonomy Code315P00000X

License✔ Licensed in IL · 38729

Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

4838 BEACON STREET, Decatur, IL 62521

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Other Names 1

Doing Business AsBeacon Street Place

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 Autumn Leaves, Inc.'s NPI number?

The NPI number for Autumn Leaves, Inc. is 1306975594. It was assigned to this organization in the NPPES registry on March 5, 2007. The provider is doing business as Beacon Street Place.

Where is Autumn Leaves, Inc. located?

Autumn Leaves, Inc. is located at 4838 Beacon Street, Decatur, IL 62521. The listed phone number is (217) 422-1761.

What is Autumn Leaves, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Autumn Leaves, Inc. was last updated on January 23, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.