=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598810061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR COMPREHENSIVE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 10/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 W MILL ST
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62901-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-529-3060
-----------------------------------------------------
Fax | 618-549-5284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2825 306 WEST MILL STREET
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62902-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-529-3060
-----------------------------------------------------
Fax | 618-549-5284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC. DIRECTOR
-----------------------------------------------------
Name | MR. SCOTT SHAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-529-3060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283XC2000X
-----------------------------------------------------
Taxonomy Name | Children's Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 4000021
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 320700000X
-----------------------------------------------------
Taxonomy Name | Physical Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number | 4000021
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------