Provider Demographics
NPI:1558837989
Name:CENTER FOR COMPREHENSIVE SERVICES, INC
Entity Type:Organization
Organization Name:CENTER FOR COMPREHENSIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-708-9444
Mailing Address - Street 1:306 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2727
Mailing Address - Country:US
Mailing Address - Phone:618-503-9061
Mailing Address - Fax:
Practice Address - Street 1:901 S BUSSE RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4006
Practice Address - Country:US
Practice Address - Phone:618-503-9061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR COMPREHENSIVE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILTBDOtherDEPARTMENT OF PUBLIC HEALTH