1114903754 NPI number — SLOVAK AMERICAN CHARITABLE ASSOCIATION

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 1114903754 NPI number — SLOVAK AMERICAN CHARITABLE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLOVAK AMERICAN CHARITABLE ASSOCIATION
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:
ROLLING HILLS MANOR
Provider Other Organization Name Type Code:
3
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:
1114903754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3615 16TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZION
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60099-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-746-8382
Provider Business Mailing Address Fax Number:
847-746-3534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3615 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60099-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-746-8382
Provider Business Practice Location Address Fax Number:
847-746-3534
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEFO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
847-746-2147

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0025239 , 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: 0025239 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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