1285896928 NPI number — HOME BRIDGE CENTER LLC

Table of content: (NPI 1285896928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285896928 NPI number — HOME BRIDGE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME BRIDGE CENTER LLC
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:
1285896928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELVIDERE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61008-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-547-5451
Provider Business Mailing Address Fax Number:
815-544-4059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELVIDERE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61008-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-547-5451
Provider Business Practice Location Address Fax Number:
815-544-4059
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PALAZZO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-885-8101

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0045674 , 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: 146071 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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