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General NPI Number Information
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NPI Number | 1972592160
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Entity Type | Organization
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Legal Business Name | CARLE HEALTHCARE, INC.
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 210 E UNIVERSITY AVE SUITE A
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3845
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Country | US
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Telephone | 816-356-3429
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Fax | 816-431-4973
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Provider Business Mailing Address
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Address Line | 210 E UNIVERSITY AVE SUITE A
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3845
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Country | US
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Telephone | 816-356-3429
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Fax | 816-431-4973
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Authorized Official
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Title or Position | DIRECTOR
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Name | LARRY SAPP
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Credential | EMT-P
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Telephone | 217-356-3459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1594559
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License Number State | IL
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