Healthcare Provider Details

I. General information

NPI: 1063533891
Provider Name (Legal Business Name): CILA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 12TH ST
FLORA IL
62839-2328
US

IV. Provider business mailing address

501 E 12TH ST
FLORA IL
62839-2328
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-7416
  • Fax:
Mailing address:
  • Phone: 618-662-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number98S012
License Number StateIL

VIII. Authorized Official

Name: MR. DAYO ADENEKAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 618-662-7416