Healthcare Provider Details

I. General information

NPI: 1255095196
Provider Name (Legal Business Name): THE CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 EASTLAND DR STE 104
BLOOMINGTON IL
61701-7904
US

IV. Provider business mailing address

1404 EASTLAND DR STE 104
BLOOMINGTON IL
61701-7904
US

V. Phone/Fax

Practice location:
  • Phone: 309-604-9690
  • Fax:
Mailing address:
  • Phone: 309-604-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES LENORD
Title or Position: CEO
Credential: MD
Phone: 217-902-5291