Provider Demographics
NPI:1386022333
Name:CENTRAL ILLILNOIS SERVICE ACCESS
Entity Type:Organization
Organization Name:CENTRAL ILLILNOIS SERVICE ACCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:QIDP
Authorized Official - Phone:217-732-4731
Mailing Address - Street 1:101 N MADIGAN DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-5445
Mailing Address - Country:US
Mailing Address - Phone:217-732-4731
Mailing Address - Fax:217-732-4870
Practice Address - Street 1:101 N MADIGAN DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-5445
Practice Address - Country:US
Practice Address - Phone:217-732-4731
Practice Address - Fax:217-732-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management