Healthcare Provider Details

I. General information

NPI: 1598810061
Provider Name (Legal Business Name): CENTER FOR COMPREHENSIVE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MILL ST
CARBONDALE IL
62901-2727
US

IV. Provider business mailing address

PO BOX 2825 306 WEST MILL STREET
CARBONDALE IL
62902-2825
US

V. Phone/Fax

Practice location:
  • Phone: 618-529-3060
  • Fax: 618-549-5284
Mailing address:
  • Phone: 618-529-3060
  • Fax: 618-549-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number4000021
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number4000021
License Number StateIL

VIII. Authorized Official

Name: MR. SCOTT SHAW
Title or Position: EXEC. DIRECTOR
Credential:
Phone: 618-529-3060