1356467948 NPI number — GEO ATHAPPILLY BLIND REHAB SPECIAL

Table of content: GEO ATHAPPILLY BLIND REHAB SPECIAL (NPI 1356467948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356467948 NPI number — GEO ATHAPPILLY BLIND REHAB SPECIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATHAPPILLY
Provider First Name:
GEO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BLIND REHAB SPECIAL
Provider Gender Code:
M

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:
1356467948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 S WOLF RD
Provider Second Line Business Mailing Address:
APT 208
Provider Business Mailing Address City Name:
HILLSIDE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60162-2164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-998-7730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5TH ST AND ROOSEVELT
Provider Second Line Business Practice Location Address:
BLDG 113
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-3556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255R0406X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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