Organization
FORUM EXTENDED CARE SERVICES OF CENTRAL ILLINOIS
Active
Other names
Forum Extended Care Services of Central Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KRAMER (PRESIDENT)
(847) 673-8727
Entity
Organization
Contact information
Practice address
2205 WABASH AVE STE 211, SPRINGFIELD, IL 62704-5356
(847) 673-8727
(847) 673-6215
Mailing address
4201 W VICTORIA ST, CHICAGO, IL 60646-6700
(847) 673-8727
(847) 673-6215
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054020139
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160632
PK
—
Enumeration date
06/16/2016
Last updated
01/31/2022
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