Provider Demographics
NPI:1689844912
Name:PARENTS AND FRIENDS OF THE COMMUNITY INTEGRATION SERVICES
Entity Type:Organization
Organization Name:PARENTS AND FRIENDS OF THE COMMUNITY INTEGRATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-310-1549
Mailing Address - Street 1:212 S. 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-310-1549
Mailing Address - Fax:618-310-1551
Practice Address - Street 1:212 S. 32ND ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-310-1549
Practice Address - Fax:618-310-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
IL311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home