Provider Demographics
NPI:1629345285
Name:COMPREHENSIVE SERVICES OF ILLINOIS INCORPORATED
Entity Type:Organization
Organization Name:COMPREHENSIVE SERVICES OF ILLINOIS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MSW, LCSW, CADC
Authorized Official - Phone:708-289-2659
Mailing Address - Street 1:2605 LINCOLN HWY
Mailing Address - Street 2:114
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1846
Mailing Address - Country:US
Mailing Address - Phone:708-503-1274
Mailing Address - Fax:708-503-1000
Practice Address - Street 1:2605 LINCOLN HWY
Practice Address - Street 2:114
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1846
Practice Address - Country:US
Practice Address - Phone:708-503-1274
Practice Address - Fax:708-503-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health