Provider Demographics
NPI:1710026745
Name:WABASH OHIO VALLEY SPECIAL EDUCATION CFC 23
Entity Type:Organization
Organization Name:WABASH OHIO VALLEY SPECIAL EDUCATION CFC 23
Other - Org Name:CHILD AND FAMILY CONNECTIONS #23
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-378-2131
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:800 S DIVISION ST
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869-0320
Mailing Address - Country:US
Mailing Address - Phone:618-378-2131
Mailing Address - Fax:618-378-3127
Practice Address - Street 1:800 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869-0320
Practice Address - Country:US
Practice Address - Phone:618-378-2131
Practice Address - Fax:618-378-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid