Provider Demographics
NPI:1306500814
Name:CENTRAL ILLINOIS SENIOR CARE, INC.
Entity type:Organization
Organization Name:CENTRAL ILLINOIS SENIOR CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KITTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-657-3533
Mailing Address - Street 1:205 S WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:MACKINAW
Mailing Address - State:IL
Mailing Address - Zip Code:61755-7524
Mailing Address - Country:US
Mailing Address - Phone:309-256-9855
Mailing Address - Fax:
Practice Address - Street 1:206 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2648
Practice Address - Country:US
Practice Address - Phone:309-657-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care