Healthcare Provider Details

I. General information

NPI: 1093945511
Provider Name (Legal Business Name): CENTER FOR COMPREHENSIVE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BROADWAY
PADUCAH KY
42001
US

IV. Provider business mailing address

P.O. BOX 2825 306 W. MILL ST
CARBONDALE IL
62902
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-3774
  • Fax: 502-254-8767
Mailing address:
  • Phone: 615-529-3060
  • Fax: 618-529-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: SERGIO P CRUZ
Title or Position: CFO
Credential:
Phone: 781-708-9444