1467426676 NPI number — BUTTERFIELD HEALTH CARE VII, LLC

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 1467426676 NPI number — BUTTERFIELD HEALTH CARE VII, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUTTERFIELD HEALTH CARE VII, 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:
6
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:
1467426676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 N RIVER RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-8949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
331-472-4500
Provider Business Mailing Address Fax Number:
331-472-4510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60525-6429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-354-4660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VANGEL
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
331-472-4500

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0047274 , 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: 0047274 . This is a "IDPH FACILITY ID NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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