Provider Demographics
NPI:1164709556
Name:ILLINOIS RIVER VALLEY PUBLIC TRANSPORT
Entity Type:Organization
Organization Name:ILLINOIS RIVER VALLEY PUBLIC TRANSPORT
Other - Org Name:CASS COUNTY MENTAL HEALTH ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISPATCHER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-323-4512
Mailing Address - Street 1:121 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-1263
Mailing Address - Country:US
Mailing Address - Phone:217-323-4512
Mailing Address - Fax:
Practice Address - Street 1:121 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-1263
Practice Address - Country:US
Practice Address - Phone:217-323-4512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)