Healthcare Provider Details

I. General information

NPI: 1225167075
Provider Name (Legal Business Name): REHABILITATION AND VOCATIONAL EDUCATION PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W DAVIE ST
ANNA IL
62906-1237
US

IV. Provider business mailing address

214 W DAVIE ST
ANNA IL
62906-1237
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-8525
  • Fax: 618-833-4222
Mailing address:
  • Phone: 618-833-8525
  • Fax: 618-833-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number00S001
License Number StateIL

VIII. Authorized Official

Name: MR. GARY L. GRIFFITH
Title or Position: C.E.O.
Credential: L.N.H.A.
Phone: 618-833-5344