Provider Demographics
NPI:1346378312
Name:TRADE INDUSTRIES
Entity Type:Organization
Organization Name:TRADE INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:618-643-4321
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MC LEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859-0070
Mailing Address - Country:US
Mailing Address - Phone:618-643-4321
Mailing Address - Fax:618-643-4230
Practice Address - Street 1:ROUTE 14 EAST
Practice Address - Street 2:
Practice Address - City:MC LEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859-0070
Practice Address - Country:US
Practice Address - Phone:618-643-4321
Practice Address - Fax:618-643-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251C00000X
IL0491320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities