Healthcare Provider Details

I. General information

NPI: 1376669267
Provider Name (Legal Business Name): CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2101
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-3420
  • Fax: 309-664-3422
Mailing address:
  • Phone: 217-383-3220
  • Fax: 217-383-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES C. LEONARD
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 217-383-3220