1154454775 NPI number — KANKAKEE COUNTY TRAINING CENTER FOR THE DISABLED, INC.

Table of content: (NPI 1154454775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154454775 NPI number — KANKAKEE COUNTY TRAINING CENTER FOR THE DISABLED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KANKAKEE COUNTY TRAINING CENTER FOR THE DISABLED, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154454775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 S SCHUYLER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADLEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60915-2341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-932-4022
Provider Business Mailing Address Fax Number:
815-932-2131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 S SCHUYLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60915-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-932-4022
Provider Business Practice Location Address Fax Number:
815-932-2131
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAINDON
Authorized Official First Name:
CHERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
REHAB. COORDINATOR
Authorized Official Telephone Number:
815-932-4022

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 347B00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HSD02903 . This is a "ROCS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".