CHARLESTON ESTATES LLC NPI 1407052079

NPI Information

  • NPI: 1407052079
  • Provider Name: CHARLESTON ESTATES, LLC
  • Classification: Point of Service - 305S00000X
  • Entity Type: Organization
  • Address: 300 LINCOLN HIGHWAY RD
    CHARLESTON, IL
    ZIP 61920
  • Phone: (217) 348-6500

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NPI Details

CHARLESTON ESTATES, LLC is a point of service in Charleston, IL. The provider is this product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. CHARLESTON ESTATES, LLC NPI is 1407052079. The provider is registered as an organization entity type.

The provider's business location address is:

300 LINCOLN HIGHWAY RD
CHARLESTON, IL
ZIP 61920-884
Phone: (217) 348-6500
Fax: (217) 345-4096

The provider's authorized official is John Holtz .
The authorized official title is Controller and has the following contact phone number (541) 747-3373.

The enumeration date for this NPI number is 6/21/2007 and was last updated on 5/14/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1305S00000XPoint of ServiceYes

What is NPI?

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This page was last updated on: 3/30/2025

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