Organization
CTF
Active
Other names
Charleston Transitional Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC EDQUIST (VICE PRESIDENT)
(708) 922-1532
Entity
Organization
Contact information
Practice address
17341 PALMER BLVD, HOMEWOOD, IL 60430-4605
(708) 922-1532
(708) 922-1526
Mailing address
1902 FOX DR STE B, CHAMPAIGN, IL 61820-7378
(217) 352-7158
(217) 352-7166
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
320900000X
IL
Other
Enumeration date
01/30/2012
Last updated
04/14/2021
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