1316136278 NPI number — ERICKSON RETIREMENT COMMUNITIES, LLC

Table of content: KEVIN DALE PERDUE M.D. (NPI 1679593420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316136278 NPI number — ERICKSON RETIREMENT COMMUNITIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERICKSON RETIREMENT COMMUNITIES, 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:
1316136278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 MAIDEN CHOICE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-5968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-402-2261
Provider Business Mailing Address Fax Number:
410-402-2264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2255 ERICKSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-4164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-300-1126
Provider Business Practice Location Address Fax Number:
630-300-1394
Provider Enumeration Date:
10/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORNE
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
EMPLOYEE HEALTH MEDICAL DIRECTOR
Authorized Official Telephone Number:
410-402-2261

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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