1982049144 NPI number — CENTRAD HEALTHCARE, LLC

Table of content: (NPI 1982049144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982049144 NPI number — CENTRAD HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAD HEALTHCARE, LLC
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:
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:
1982049144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
184 SHUMAN BLVD
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8549 CORDES CIR
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38139-3370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-755-8412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KORSLIN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-369-5840

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000001084 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1519732 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000001084 . This is a "HOME MEDICAL EQUIPMENT LICENSURE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".