Provider Demographics
NPI:1073843165
Name:KREIDER SERVICES INCORPORATED
Entity Type:Organization
Organization Name:KREIDER SERVICES INCORPORATED
Other - Org Name:NEW MAIN GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-288-6691
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-0366
Mailing Address - Country:US
Mailing Address - Phone:815-288-6691
Mailing Address - Fax:815-288-1636
Practice Address - Street 1:1201 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3977
Practice Address - Country:US
Practice Address - Phone:815-288-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039057315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities