Provider Demographics
NPI:1508243361
Name:CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL
Entity Type:Organization
Organization Name:CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERDIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MA CADC
Authorized Official - Phone:217-348-8108
Mailing Address - Street 1:635 DIVISION ST
Mailing Address - Street 2:P.O. BOX 532
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-1902
Mailing Address - Country:US
Mailing Address - Phone:217-348-8108
Mailing Address - Fax:217-345-6794
Practice Address - Street 1:416 N 19TH ST
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-2842
Practice Address - Country:US
Practice Address - Phone:217-348-8108
Practice Address - Fax:217-345-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0631-0003-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA-0631-0003-AMedicaid