Provider Demographics
NPI:1598810061
Name:CENTER FOR COMPREHENSIVE SERVICES, INC.
Entity Type:Organization
Organization Name:CENTER FOR COMPREHENSIVE SERVICES, INC.
Other - Org Name:NEURORESTORATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-529-3060
Mailing Address - Street 1:PO BOX 2825
Mailing Address - Street 2:306 WEST MILL STREET
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-2825
Mailing Address - Country:US
Mailing Address - Phone:618-529-3060
Mailing Address - Fax:618-549-5284
Practice Address - Street 1:306 W MILL ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2727
Practice Address - Country:US
Practice Address - Phone:618-529-3060
Practice Address - Fax:618-549-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000021283X00000X, 313M00000X
283XC2000X, 314000000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No283XC2000XHospitalsRehabilitation HospitalChildren
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2005-29-001-K1Medicaid
KY45913258Medicaid
039-19396OtherBCBS IL OUTPATIENT
IA0650283Medicaid
KS100389900BMedicaid
IA0650077Medicaid
V69DP-3420OtherVA
IA0090092Medicaid
TN5440970Medicaid
IA0650275Medicaid
IN100379610AMedicaid
IA0650275Medicaid
KY45913258Medicaid