1053830828 NPI number — CARING SHEPHERDS HEALTH CARE INC

Table of content: (NPI 1053830828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053830828 NPI number — CARING SHEPHERDS HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARING SHEPHERDS HEALTH CARE 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:
1053830828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15525 S PARK AVE STE 103B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HOLLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60473-1379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-331-4214
Provider Business Mailing Address Fax Number:
708-331-4216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15525 SOUTH PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 103B
Provider Business Practice Location Address City Name:
SOUTH HOLLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-331-4214
Provider Business Practice Location Address Fax Number:
708-331-4216
Provider Enumeration Date:
09/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
OPAKUNLE
Authorized Official First Name:
FOLARIN
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
708-331-4214

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  4000533 , 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: 4000533 . This is a "IDPH LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com