Healthcare Provider Details

I. General information

NPI: 1902916133
Provider Name (Legal Business Name): CAREPAKS HEALTH SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SUSAN DR
NORMAL IL
61761-6188
US

IV. Provider business mailing address

209 SUSAN DR
NORMAL IL
61761-6188
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-1000
  • Fax: 309-454-5000
Mailing address:
  • Phone: 309-454-1000
  • Fax: 309-454-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1009265
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5569640001
License Number StateIL

VIII. Authorized Official

Name: MRS. CATHY C. EBO
Title or Position: DIRECTOR
Credential: R.N.
Phone: 309-454-1000