Provider Demographics
NPI:1265601397
Name:COMMUNITY WORKSHOP AND TRAINING CENTER, INC
Entity type:Organization
Organization Name:COMMUNITY WORKSHOP AND TRAINING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-686-3307
Mailing Address - Street 1:3215 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1318
Mailing Address - Country:US
Mailing Address - Phone:309-686-3300
Mailing Address - Fax:309-686-0316
Practice Address - Street 1:3215 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1318
Practice Address - Country:US
Practice Address - Phone:309-686-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========002Medicaid
IL=========005Medicaid
IL=========6610401OtherHFS
IL=========661402OtherHFS
IL=========004Medicaid
IL=========003Medicaid