Provider Demographics
NPI:1740952217
Name:CRAIN DIAGNOSTICS PLLC
Entity type:Organization
Organization Name:CRAIN DIAGNOSTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRE
Authorized Official - Middle Name:LEONA
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:FPA,FNP-BC
Authorized Official - Phone:170-888-2053
Mailing Address - Street 1:17066 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3369
Mailing Address - Country:US
Mailing Address - Phone:170-888-2053
Mailing Address - Fax:647-799-2792
Practice Address - Street 1:17066 S PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3369
Practice Address - Country:US
Practice Address - Phone:708-882-0532
Practice Address - Fax:647-799-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service