1902916133 NPI number — CAREPAKS HEALTH SERVICES INCORPORATED

Table of content: (NPI 1902916133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902916133 NPI number — CAREPAKS HEALTH SERVICES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREPAKS HEALTH SERVICES INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902916133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 SUSAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61761-6188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-454-1000
Provider Business Mailing Address Fax Number:
309-454-5000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 SUSAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61761-6188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-454-1000
Provider Business Practice Location Address Fax Number:
309-454-5000
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EBO
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
309-454-1000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5569640001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 1009265 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02006-N048 . This is a "DEPT. OF LABOR/STAFFING" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1009265 . This is a "HOME HEALTH CERTIFICATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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