Provider Demographics
NPI:1588922793
Name:COLES COUNTY SHUTTLE SERVICE, INC.
Entity type:Organization
Organization Name:COLES COUNTY SHUTTLE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERICAL
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-348-7074
Mailing Address - Street 1:14761 OLD STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-7662
Mailing Address - Country:US
Mailing Address - Phone:217-348-7074
Mailing Address - Fax:
Practice Address - Street 1:14761 OLD STATE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-7662
Practice Address - Country:US
Practice Address - Phone:217-348-7074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi