Healthcare Provider Details

I. General information

NPI: 1184676579
Provider Name (Legal Business Name): PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W PARK ST
URBANA IL
61801-9901
US

IV. Provider business mailing address

1400 W PARK ST
URBANA IL
61801-9901
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-5000
  • Fax: 217-477-2761
Mailing address:
  • Phone: 217-443-5000
  • Fax: 217-477-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number0004861
License Number StateIL

VIII. Authorized Official

Name: RICHARD DOUGLAS CARTER
Title or Position: AMITA CFO
Credential:
Phone: 224-273-2350