Provider Demographics
NPI:1346243979
Name:CENTRAD HEALTHCARE LLC
Entity Type:Organization
Organization Name:CENTRAD HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:KORSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-369-5840
Mailing Address - Street 1:184 SHUMAN BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8474
Mailing Address - Country:US
Mailing Address - Phone:630-369-5840
Mailing Address - Fax:630-369-5436
Practice Address - Street 1:184 SHUMAN BLVD
Practice Address - Street 2:STE 130
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8474
Practice Address - Country:US
Practice Address - Phone:630-369-5840
Practice Address - Fax:630-369-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000502332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18130372Medicaid
IA0530980Medicaid
MN221343500Medicaid
NJ8705402Medicaid
AKMS284ILMedicaid
KS75 871044 01Medicaid
NY02163179Medicaid
IN200287520AMedicaid
AR520115Medicaid
MD8251002 00Medicaid
CT003107879Medicaid
GA00876191AMedicaid
IL02230052OtherBLUE CROSS BLUE SHIELD
ND52482Medicaid
MS00440846Medicaid
AL009974810Medicaid
LA1431532Medicaid
IL=========001Medicaid
CT003107879Medicaid
CO18130372Medicaid