Provider Demographics
NPI:1013147289
Name:CENTRAL ILLINOIS AUTISM THERAPEUTIC SERVICES, NFP
Entity Type:Organization
Organization Name:CENTRAL ILLINOIS AUTISM THERAPEUTIC SERVICES, NFP
Other - Org Name:CIATS
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR/SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SKELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-821-1752
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0767
Mailing Address - Country:US
Mailing Address - Phone:217-258-5790
Mailing Address - Fax:217-345-0910
Practice Address - Street 1:26 KICKAPOO VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-8086
Practice Address - Country:US
Practice Address - Phone:217-258-5790
Practice Address - Fax:217-345-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency