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General NPI Number Information
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NPI Number | 1306500814
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Entity Type | Organization
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Legal Business Name | CENTRAL ILLINOIS SENIOR CARE, INC.
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Dates
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Enumeration Date | 10/30/2021
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 206 WALNUT ST
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City | WASHINGTON
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State | IL
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Zip | 61571-2648
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Country | US
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Telephone | 309-657-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 205 S WEBSTER ST
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City | MACKINAW
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State | IL
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Zip | 61755-7524
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Country | US
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Telephone | 309-256-9855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA LEE KITTERMAN
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Credential |
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Telephone | 309-657-3533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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