1003801093 NPI number — BIRCHWOOD PLAZA INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003801093 NPI number — BIRCHWOOD PLAZA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIRCHWOOD PLAZA 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:
1003801093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1426 W BIRCHWOOD AVE
Provider Second Line Business Mailing Address:
1426 W. BIRCHWOOD AVE.
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60626-1807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-274-4405
Provider Business Mailing Address Fax Number:
773-274-4412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1426 W BIRCHWOOD AVE
Provider Second Line Business Practice Location Address:
1426 W. BIRCHWOOD AVE.
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60626-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-274-4405
Provider Business Practice Location Address Fax Number:
773-274-4412
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHIFFMAN
Authorized Official First Name:
ABRAHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
773-274-4405

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0028696 , 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)





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