Provider Demographics
NPI:1316253388
Name:KASKASKIA WORKSHOP, INC.
Entity type:Organization
Organization Name:KASKASKIA WORKSHOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-533-4423
Mailing Address - Street 1:299 SWAN AVE
Mailing Address - Street 2:PO BOX 1946
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-6127
Mailing Address - Country:US
Mailing Address - Phone:618-548-1878
Mailing Address - Fax:618-548-1679
Practice Address - Street 1:299 SWAN AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-6127
Practice Address - Country:US
Practice Address - Phone:618-548-1878
Practice Address - Fax:618-548-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency