CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL NPI 1508243361

NPI Information

NPI: 1508243361
Provider Name: CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 14D2030094

Address:
416 N 19TH ST
MATTOON, IL
ZIP 61938
Phone: (217) 348-8108
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CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL is a rehabilitation and substance use disorder clinic center in Mattoon, IL. CENTRAL EAST ALCOHOLISM AND DRUG COUNCIL NPI is 1508243361. The provider is registered as an organization entity type.

The provider's business location address is:

416 N 19TH ST
MATTOON, IL
ZIP 61938-842
Phone: (217) 348-8108
Fax: (217) 345-6794

The provider's authorized official is Teressa M. Perdieu .
The authorized official title is Executive Director and has the following contact phone number (217) 348-8108.

The CLIA number assigned to this NPI record is 14D2030094 - other - residential facility trea with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/30/2015 and was last updated on 10/22/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	A-0631-0003-A	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CA-0631-0003-A	MEDICAID	ILLINOIS

What is NPI?

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This page was last updated on: 5/5/2024

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