Provider Demographics
NPI:1174997779
Name:SPECIALIZED TRAINING FOR ADULT REHABILITATION, INC
Entity type:Organization
Organization Name:SPECIALIZED TRAINING FOR ADULT REHABILITATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-687-2378
Mailing Address - Street 1:20 N 13TH ST
Mailing Address - Street 2:PO BOX 938
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-2057
Mailing Address - Country:US
Mailing Address - Phone:618-687-2378
Mailing Address - Fax:618-687-2733
Practice Address - Street 1:20 N 13TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2057
Practice Address - Country:US
Practice Address - Phone:618-687-2378
Practice Address - Fax:618-687-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL199100121S251B00000X, 320900000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities