Provider Demographics
NPI:1578775730
Name:BK SERVICES
Entity Type:Organization
Organization Name:BK SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:UTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-690-4846
Mailing Address - Street 1:802 N GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3200
Mailing Address - Country:US
Mailing Address - Phone:217-690-4846
Mailing Address - Fax:217-690-4846
Practice Address - Street 1:802 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3200
Practice Address - Country:US
Practice Address - Phone:217-690-4846
Practice Address - Fax:217-690-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352502133001Medicaid