Provider Demographics
NPI:1821582131
Name:THE CARLE FOUNDATION HOSPITAL
Entity Type:Organization
Organization Name:THE CARLE FOUNDATION HOSPITAL
Other - Org Name:CARLE HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-383-3311
Mailing Address - Street 1:221 N BROADWAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2748
Mailing Address - Country:US
Mailing Address - Phone:217-383-3099
Mailing Address - Fax:217-355-6789
Practice Address - Street 1:221 N BROADWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2748
Practice Address - Country:US
Practice Address - Phone:217-383-3099
Practice Address - Fax:217-355-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251F00000XAgenciesHome Infusion