Provider Demographics
NPI:1346415874
Name:KREIDER SERVICES, INC.
Entity Type:Organization
Organization Name:KREIDER SERVICES, INC.
Other - Org Name:
Other - Org Type:
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 1:408 N ELM ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN GROVE
Practice Address - State:IL
Practice Address - Zip Code:61031-9598
Practice Address - Country:US
Practice Address - Phone:815-288-6691
Practice Address - Fax:815-288-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL39040315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========009Medicaid