1. Home
  2. Directory
  3. Illinois
  4. Decatur
  5. Intermediate Care Facility Mentally Retarded
  6. NPI Profile

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

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: July 19, 2026.

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
Open in Google Maps ↗

Other Names 1

Doing Business AsBeacon Street Place

Frequently Asked Questions

What is AUTUMN LEAVES, INC.'s NPI number?

The NPI number assigned to this healthcare provider is 1306975594, enumerated as an "organization" on March 05, 2007.

Where is the provider located?

The provider is located at 4838 BEACON STREET DECATUR, IL 62521 and the phone number is (217) 422-1761.

What is the provider's specialty?

Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.