1780719112 NPI number — HOWE CENTER - UNIT 4261

Table of content: (NPI 1780719112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780719112 NPI number — HOWE CENTER - UNIT 4261

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWE CENTER - UNIT 4261
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:
1780719112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7600 183RD ST
Provider Second Line Business Mailing Address:
UNIT 4261
Provider Business Mailing Address City Name:
TINLEY PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60477-3690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-614-3515
Provider Business Mailing Address Fax Number:
708-532-7289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 183RD ST
Provider Second Line Business Practice Location Address:
UNIT 4261
Provider Business Practice Location Address City Name:
TINLEY PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60477-3690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-614-3515
Provider Business Practice Location Address Fax Number:
708-532-7289
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CANNA
Authorized Official First Name:
JAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CENTER DIRECTOR
Authorized Official Telephone Number:
708-614-3515

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  6009666 , 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: 000984261001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com