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General NPI Number Information
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NPI Number | 1346787546
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Entity Type | Organization
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Legal Business Name | CARLYLE HEALTHCARE CENTER
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 501 CLINTON ST
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City | CARLYLE
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State | IL
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Zip | 62231-1503
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Country | US
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Telephone | 618-594-3112
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Fax | 618-594-2393
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Provider Business Mailing Address
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Address Line | 501 CLINTON ST
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City | CARLYLE
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State | IL
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Zip | 62231-1503
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Country | US
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Telephone | 618-594-3112
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Fax | 618-594-2393
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. CHRISTOPHER ANDREW REIS
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Credential | LNHA
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Telephone | 618-594-3112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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