Healthcare Provider Details

I. General information

NPI: 1619034659
Provider Name (Legal Business Name): THE CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2500
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-326-2911
  • Fax: 217-344-8047
Mailing address:
  • Phone: 217-326-2911
  • Fax: 217-344-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number0003798
License Number StateIL

VIII. Authorized Official

Name: JAMES LEONARD
Title or Position: CEO
Credential:
Phone: 217-383-3221