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General NPI Number Information
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NPI Number | 1386022333
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Entity Type | Organization
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Legal Business Name | CENTRAL ILLILNOIS SERVICE ACCESS
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 101 N MADIGAN DR
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City | LINCOLN
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State | IL
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Zip | 62656-5445
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Country | US
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Telephone | 217-732-4731
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Fax | 217-732-4870
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Provider Business Mailing Address
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Address Line | 101 N MADIGAN DR
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City | LINCOLN
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State | IL
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Zip | 62656-5445
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Country | US
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Telephone | 217-732-4731
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Fax | 217-732-4870
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LEANNDRA KELTNER
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Credential | QIDP
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Telephone | 217-732-4731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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