Healthcare Provider Details

I. General information

NPI: 1316185622
Provider Name (Legal Business Name): KREIDER SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ANCHOR RD
DIXON IL
61021-8829
US

IV. Provider business mailing address

500 ANCHOR RD
DIXON IL
61021-8829
US

V. Phone/Fax

Practice location:
  • Phone: 815-288-6691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number146.008250
License Number StateIL

VIII. Authorized Official

Name: TRINA O'BRIEN
Title or Position: COMMUNITY SERVICES MANAGER
Credential:
Phone: 815-288-6691