Provider Demographics
NPI:1821202417
Name:ALCOHOL CHEMICAL EVALUATION SERVICES
Entity Type:Organization
Organization Name:ALCOHOL CHEMICAL EVALUATION SERVICES
Other - Org Name:ACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DRIVER-DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-344-2671
Mailing Address - Street 1:217 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2706
Mailing Address - Country:US
Mailing Address - Phone:217-344-2671
Mailing Address - Fax:217-344-2819
Practice Address - Street 1:217 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2706
Practice Address - Country:US
Practice Address - Phone:217-344-2671
Practice Address - Fax:217-344-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-7511-0001-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001032040OtherBLUE SHIELD ID #