Provider Demographics
NPI:1851387385
Name:THE CARLE FOUNDATION HOSPITAL
Entity Type:Organization
Organization Name:THE CARLE FOUNDATION HOSPITAL
Other - Org Name:CARLE HOSPICE
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:
Authorized Official - Phone:217-383-3221
Mailing Address - Street 1:611 W PARK
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:217-383-3311
Mailing Address - Fax:217-355-8133
Practice Address - Street 1:4116 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-8801
Practice Address - Country:US
Practice Address - Phone:217-383-3151
Practice Address - Fax:217-355-8133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CARLE FOUNDATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-20
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2000966251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL37119538002Medicaid
IL37119538002Medicaid