Provider Demographics
NPI:1659493229
Name:WARREN ACHIEVEMENT CENTER
Entity Type:Organization
Organization Name:WARREN ACHIEVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-734-3131
Mailing Address - Street 1:1220 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-2404
Mailing Address - Country:US
Mailing Address - Phone:309-734-3131
Mailing Address - Fax:309-734-7114
Practice Address - Street 1:1220 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-2404
Practice Address - Country:US
Practice Address - Phone:309-734-3131
Practice Address - Fax:309-734-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty