Provider Demographics
NPI:1760804629
Name:CENTER FOR DISABILITY SERVICES
Entity Type:Organization
Organization Name:CENTER FOR DISABILITY SERVICES
Other - Org Name:UNITED CEREBRAL PALSY OF ILLINOIS PRAIRIELAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRENYA NOAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-744-3500
Mailing Address - Street 1:311 S REED ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436
Mailing Address - Country:US
Mailing Address - Phone:815-744-3500
Mailing Address - Fax:815-744-3504
Practice Address - Street 1:311 S REED ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436
Practice Address - Country:US
Practice Address - Phone:815-744-3500
Practice Address - Fax:815-744-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251C00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services