Provider Demographics
NPI:1891823662
Name:WASHINGTON COUNTY VOCATIONAL WORKSHOP
Entity Type:Organization
Organization Name:WASHINGTON COUNTY VOCATIONAL WORKSHOP
Other - Org Name:WASHINGTON COUNTY COMMUNITY COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CURRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-327-4461
Mailing Address - Street 1:781 E. HOLZHAUER DR.
Mailing Address - Street 2:P.O. BOX 273
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-0273
Mailing Address - Country:US
Mailing Address - Phone:618-327-4461
Mailing Address - Fax:618-327-4477
Practice Address - Street 1:781 E. HOLZHAUER DR.
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-0273
Practice Address - Country:US
Practice Address - Phone:618-327-4461
Practice Address - Fax:618-327-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251C00000X
IL04145251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========Medicaid