1215083316 NPI number — CENTER FOR COMPREHENSIVE SERVICES, INC.

Table of content: (NPI 1215083316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215083316 NPI number — CENTER FOR COMPREHENSIVE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COMPREHENSIVE SERVICES, 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:
1215083316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2825
Provider Second Line Business Mailing Address:
306 WEST MILL STREET
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62902-2825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-529-3060
Provider Business Mailing Address Fax Number:
618-529-2983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
268 GOVERNOR HALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTALIAN SPRINGS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37031-4721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-451-5590
Provider Business Practice Location Address Fax Number:
615-451-5591
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUTLER
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
618-529-3060

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5440971 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".