Provider Demographics
NPI:1265605117
Name:CARLE FOUNDATION HOSPITAL
Entity type:Organization
Organization Name:CARLE FOUNDATION HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SELLETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:217-383-3488
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:217-367-2827
Practice Address - Street 1:509 WEST UNIVERSITY
Practice Address - Street 2:SUITE 1201
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-326-3168
Practice Address - Fax:217-367-2827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLE FOUNDATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0409020016Medicare NSC