Basic Information
| Provider Information | |||||||||
| NPI: | 1225410434 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY ALTERNATIVES ILLINOIS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9901 LINN STATION RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402233808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023942100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 885 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609014701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159293745 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2015 | ||||||||
| LastUpdateDate: | 06/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | OMBRES | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOC. GEN. COUNSEL/PRIVACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5023942100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | IL | Y | Agencies | Community/Behavioral Health |
No ID Information.