Provider Demographics
NPI:1285842161
Name:CENTRAL ILLINOIS REHABILITATION ASSOCIATES INC SC
Entity Type:Organization
Organization Name:CENTRAL ILLINOIS REHABILITATION ASSOCIATES INC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-687-5450
Mailing Address - Street 1:4422 N BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5509
Mailing Address - Country:US
Mailing Address - Phone:309-687-5450
Mailing Address - Fax:309-687-5419
Practice Address - Street 1:4422 N BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5509
Practice Address - Country:US
Practice Address - Phone:309-687-5450
Practice Address - Fax:309-687-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation