Healthcare Provider Details

I. General information

NPI: 1104173855
Provider Name (Legal Business Name): CENTER FOR COMPREHENSIVE SERVICES, INC DBA NEURORESTORATIVE KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 SHELBYVILLE RD
LOUISVILLE KY
40243-1040
US

IV. Provider business mailing address

PO BOX 2825
CARBONDALE IL
62902-2825
US

V. Phone/Fax

Practice location:
  • Phone: 502-491-0941
  • Fax: 502-491-0942
Mailing address:
  • Phone: 618-529-3060
  • Fax: 618-529-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER JOHN WILLIAMSON
Title or Position: VICE PRESIDENT OPERATIONS
Credential:
Phone: 618-529-3060