Healthcare Provider Details

I. General information

NPI: 1437275328
Provider Name (Legal Business Name): THE CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 PARK DR
CHARLESTON IL
61920-9466
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-3640
  • Fax: 217-258-3648
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/CEO
Credential: MD
Phone: 217-326-4677