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General NPI Number Information
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NPI Number | 1285842161
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Entity Type | Organization
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Legal Business Name | CENTRAL ILLINOIS REHABILITATION ASSOCIATES INC SC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 4422 N BRANDYWINE DR
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City | PEORIA
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State | IL
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Zip | 61614-5509
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Country | US
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Telephone | 309-687-5450
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Fax | 309-687-5419
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Provider Business Mailing Address
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Address Line | 4422 N BRANDYWINE DR
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City | PEORIA
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State | IL
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Zip | 61614-5509
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Country | US
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Telephone | 309-687-5450
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Fax | 309-687-5419
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD ALLEN FLORES
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Credential | MD
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Telephone | 309-687-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | IL
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