Provider Demographics
NPI:1518959642
Name:CARLYLE HEALTHCARE CENTER INC.
Entity Type:Organization
Organization Name:CARLYLE HEALTHCARE CENTER INC.
Other - Org Name:CARLYLE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-594-3112
Mailing Address - Street 1:501 CLINTON STREET
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-1503
Mailing Address - Country:US
Mailing Address - Phone:618-594-3112
Mailing Address - Fax:618-594-2393
Practice Address - Street 1:501 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-1503
Practice Address - Country:US
Practice Address - Phone:618-594-3112
Practice Address - Fax:618-594-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL145729Medicare Oscar/Certification
IL145729Medicare ID - Type Unspecified