Provider Demographics
NPI:1538304936
Name:INDIVIDUALIZED SERVICES, INC.
Entity Type:Organization
Organization Name:INDIVIDUALIZED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMMARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, QMRP
Authorized Official - Phone:309-262-8006
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-0064
Mailing Address - Country:US
Mailing Address - Phone:309-262-8006
Mailing Address - Fax:309-807-2768
Practice Address - Street 1:1322 N LINDEN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-1939
Practice Address - Country:US
Practice Address - Phone:309-262-8006
Practice Address - Fax:309-807-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management