Provider Demographics
NPI:1386033249
Name:CENTRAD HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CENTRAD HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:60563-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5110 GRANITE ST
Practice Address - Street 2:SUITE C
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-1687
Practice Address - Country:US
Practice Address - Phone:970-775-2149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.001067332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18130372Medicaid