MEDICARE: EASTERN ILLINOIS AREA OF SPECIAL EDUCATION

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1699874719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN ILLINOIS AREA OF SPECIAL EDUCATION

Provider Business Mailing Address
First Line	:	5837 PARK DR
Second Line	:	SUITE 1
City	:	CHARLESTON
State	:	IL
Zip	:	61920-9460
Country	:	US
Telephone Number	:	217-348-7700
Fax Number	:	217-348-7704

Provider Business Practice Location Address
First Line	:	5837 PARK DR
Second Line	:	SUITE 1
City	:	CHARLESTON
State	:	IL
Zip	:	61920-9460
Country	:	US
Telephone Number	:	217-348-7700
Fax Number	:	217-348-7704

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL ALT
Credential	:
Telephone Number	:	217-348-7700

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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Directions to “EASTERN ILLINOIS AREA OF SPECIAL EDUCATION ” Practice Location

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