Provider Demographics
NPI:1568671998
Name:CARLE FOUNDATION HOSPITAL
Entity Type:Organization
Organization Name:CARLE FOUNDATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERD NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-383-3088
Mailing Address - Street 1:1902 E AMBER LN
Mailing Address - Street 2:APT 207
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-7104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren