Basic Information
| Provider Information | |||||||||
| NPI: | 1750446373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KREIDER SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ANCHOR ROAD | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610218829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152886691 | ||||||||
| FaxNumber: | 8152881636 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ANCHOR ROAD | ||||||||
| Address2: | |||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610218829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152886691 | ||||||||
| FaxNumber: | 8152881636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | OBRIEN | ||||||||
| AuthorizedOfficialFirstName: | TRINA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | COMMUNITY SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8152886691 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | IL | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 251B00000X | IL | N | Agencies | Case Management | 251C00000X | IL | N | Agencies | Day Training, Developmentally Disabled Services | 222Q00000X | IL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 103TC2200X | 071007493 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 225X00000X | 056005546 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | 14600657 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 146008250 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | 070002814 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 056006700 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 252Y00000X | IL | Y | Agencies | Early Intervention Provider Agency |
No ID Information.