1619964079 NPI number — MORROW HEALTH CARE CENTER, INC.

Table of content: (NPI 1619964079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619964079 NPI number — MORROW HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORROW HEALTH CARE 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:
1619964079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 W PETERSON AVE
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60646-6074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-286-6622
Provider Business Mailing Address Fax Number:
773-286-2150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 S MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-924-9292
Provider Business Practice Location Address Fax Number:
773-924-1308
Provider Enumeration Date:
09/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHLOSSBERG
Authorized Official First Name:
FLOYD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-286-6622

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0019596 , 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)

  • Identifier: 1007 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".