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General NPI Number Information
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NPI Number | 1689024036
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Entity Type | Organization
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Legal Business Name | FORUM EXTENDED CARE SERVICES OF CENTRAL ILLINOIS
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 2205 WABASH AVE STE 211
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City | SPRINGFIELD
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State | IL
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Zip | 62704-5356
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Country | US
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Telephone | 847-673-8727
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Fax | 847-673-6215
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Provider Business Mailing Address
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Address Line | 4201 W VICTORIA ST
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City | CHICAGO
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State | IL
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Zip | 60646-6700
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Country | US
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Telephone | 847-673-8727
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Fax | 847-673-6215
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN KRAMER
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Credential |
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Telephone | 847-673-8727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 054020139
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License Number State | IL
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