Healthcare Provider Details

I. General information

NPI: 1588701429
Provider Name (Legal Business Name): CCAR INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LINCOLN AVE
CHARLESTON IL
61920-3057
US

IV. Provider business mailing address

1530 LINCOLN AVE
CHARLESTON IL
61920-3057
US

V. Phone/Fax

Practice location:
  • Phone: 217-348-0127
  • Fax: 217-345-2968
Mailing address:
  • Phone: 217-348-0127
  • Fax: 217-345-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYLA MCGUIRE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-348-0127