Provider Demographics
NPI:1215403241
Name:CEP AMERICA - ILLINOIS SNF, LLP
Entity Type:Organization
Organization Name:CEP AMERICA - ILLINOIS SNF, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILE
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-350-2600
Mailing Address - Street 1:2100 POWELL ST STE 900
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1844
Mailing Address - Country:US
Mailing Address - Phone:510-350-2600
Mailing Address - Fax:
Practice Address - Street 1:601 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1306
Practice Address - Country:US
Practice Address - Phone:618-345-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty