Provider Demographics
NPI: | 1750446373 |
---|---|
Name: | KREIDER SERVICES INC |
Entity Type: | Organization |
Organization Name: | KREIDER SERVICES INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COMMUNITY SERVICES MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | TRINA |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | OBRIEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 815-288-6691 |
Mailing Address - Street 1: | 500 ANCHOR ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | DIXON |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 61021-8829 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 815-288-6691 |
Mailing Address - Fax: | 815-288-1636 |
Practice Address - Street 1: | 500 ANCHOR ROAD |
Practice Address - Street 2: | |
Practice Address - City: | DIXON |
Practice Address - State: | IL |
Practice Address - Zip Code: | 61021-8829 |
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: | 2006-12-26 |
Last Update Date: | 2016-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 071007493 | 103TC2200X |
IL | 222Q00000X, 251B00000X, 251C00000X, 252Y00000X, 320900000X | |
IL | 070002814 | 225100000X |
IL | 056006700 | 225X00000X |
IL | 056005546 | 225X00000X |
IL | 14600657 | 235Z00000X |
IL | 146008250 | 235Z00000X |
332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty | |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |