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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |