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
StateLicense IDTaxonomies
IL071007493103TC2200X
IL222Q00000X, 251B00000X, 251C00000X, 252Y00000X, 320900000X
IL070002814225100000X
IL056006700225X00000X
IL056005546225X00000X
IL14600657235Z00000X
IL146008250235Z00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty