Provider Demographics
NPI:1255095196
Name:THE CARLE FOUNDATION HOSPITAL
Entity type:Organization
Organization Name:THE CARLE FOUNDATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LENORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-902-5291
Mailing Address - Street 1:1404 EASTLAND DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7904
Mailing Address - Country:US
Mailing Address - Phone:309-604-9690
Mailing Address - Fax:
Practice Address - Street 1:1404 EASTLAND DR STE 104
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7904
Practice Address - Country:US
Practice Address - Phone:309-604-9690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CARLE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies