MEDICARE: CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	A-0631-0001-A	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649657180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL

Provider Business Mailing Address
First Line	:	635 DIVISION ST
Second Line	:	P.O. BOX 532
City	:	CHARLESTON
State	:	IL
Zip	:	61920-1902
Country	:	US
Telephone Number	:	217-348-8108
Fax Number	:	217-345-6794

Provider Business Practice Location Address
First Line	:	1501 1/2 18TH ST
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-3603
Country	:	US
Telephone Number	:	217-348-8108
Fax Number	:	217-345-6794

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TERESSA M. PERDIEU
Credential	:	MA CADC
Telephone Number	:	217-348-8108

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	10/22/2018

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