National Provider Identifier Database

BACKROAD HEALTH CARE INC
Family


Contact Information

BACKROAD HEALTH CARE INC
211 S PERRINE AVE
CENTRALIA, IL62801-3635
Phone: 618-419-0011
Fax: 888-980-2931
Website:
Specialty Taxonomy Code
* Family 363LF0000X

* Indicates primary specialty

NPI Profile & details for BACKROAD HEALTH CARE INC

NPI Number 1134582018
Legal business name
LBN
BACKROAD HEALTH CARE INC
Authorized official PAUL HAVRILKA - (FNP/OWNER)
Entity Organization
Organization subpart No
Enumeration date 03/30/2016
Last updated 03/18/2019 - About 7 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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