You must submit the following documents:

Send the completed documents to the address below:

Department of Human Services
Division of Developmental Disabilities
319 E. Madison Street, Suite 3M
Springfield, IL 62701

Fax: (217) 558-2799

Attention: Provider Enrollment

You are required to obtain a National Provider Identification Number (NPI) for CILA services.

Please see web site on National Provider Identification Number

Note:  All health care bills submitted electronically to any DHS program will be denied if the provider of health care services does not have an NPI number registered with HFS. Your NPI number is registered by HFS at the time of enrollment. The NPI number is entered on your form HFS 2243.

Important Resources for Requirements