Healthcare Provider Details

I. General information

NPI: 1437465325
Provider Name (Legal Business Name): CARLE HEALTH CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR PHYSICIANS PLAZA EAST, SUITE 300
DECATUR IL
62526-6303
US

IV. Provider business mailing address

1 MEMORIAL DR PHYSICIANS PLAZA EAST, SUITE 300
DECATUR IL
62526-6303
US

V. Phone/Fax

Practice location:
  • Phone: 217-875-5545
  • Fax:
Mailing address:
  • Phone: 217-875-5545
  • 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: JOHN SNYDER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 217-326-4677