Provider Demographics
NPI:1154797074
Name:LAWRENCE CRAWFORD ASSOCIATION FOR EXCEPTIONAL CITIZENS
Entity type:Organization
Organization Name:LAWRENCE CRAWFORD ASSOCIATION FOR EXCEPTIONAL CITIZENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-546-5625
Mailing Address - Street 1:905 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1646
Mailing Address - Country:US
Mailing Address - Phone:618-546-5625
Mailing Address - Fax:618-546-1519
Practice Address - Street 1:905 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1646
Practice Address - Country:US
Practice Address - Phone:618-546-5625
Practice Address - Fax:618-546-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services