1023006848 NPI number — TIMBER POINT HEALTHCARE CENTER INC

Table of content: (NPI 1023006848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023006848 NPI number — TIMBER POINT HEALTHCARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMBER POINT HEALTHCARE CENTER INC
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:
1023006848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60202-1519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-905-4026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP POINT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62320-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-593-7734
Provider Business Practice Location Address Fax Number:
217-593-6360
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHAN-MARTIN
Authorized Official First Name:
JENNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
847-905-4026

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0043158 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com