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General NPI Number Information
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NPI Number | 1538304936
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Entity Type | Organization
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Legal Business Name | INDIVIDUALIZED SERVICES, INC.
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Dates
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Enumeration Date | 12/14/2008
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Last Update Date | 12/14/2008
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Provider Practice Location Address
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Address Line | 1322 N LINDEN ST
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City | BLOOMINGTON
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State | IL
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Zip | 61701-1939
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Country | US
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Telephone | 309-262-8006
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Fax | 309-807-2768
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Provider Business Mailing Address
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Address Line | PO BOX 64
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City | BLOOMINGTON
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State | IL
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Zip | 61702-0064
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Country | US
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Telephone | 309-262-8006
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Fax | 309-807-2768
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KIMMARIE ANN BROWN
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Credential | M.A., QMRP
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Telephone | 309-262-8006
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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 | 251B00000X
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License Number State | IL
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