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General NPI Number Information
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NPI Number | 1871968495
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Entity Type | Organization
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Legal Business Name | CRA, INC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 816 WYATT AVE
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City | LINCOLN
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State | IL
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Zip | 62656-3145
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Country | US
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Telephone | 217-735-5203
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Fax |
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Provider Business Mailing Address
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Address Line | 4102 FARHILLS DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-9301
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Country | US
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Telephone | 217-693-7494
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Fax | 734-342-6402
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CARRIE LYNN VALETE
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Credential |
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Telephone | 217-693-7494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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