1356968457 NPI number — CARITAS

Table of content: MISS EMMA GRACE CARTER (NPI 1386343424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356968457 NPI number — CARITAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARITAS
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:
1356968457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 W 22ND ST STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-572-8228
Provider Business Mailing Address Fax Number:
630-572-0566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 N ASHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60607-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-850-9411
Provider Business Practice Location Address Fax Number:
312-850-3288
Provider Enumeration Date:
07/06/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
JESSECA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
630-572-8228

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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