1720422959 NPI number — TRANSITIONAL ALTERNATIVE REENTRY INITIATIVE, INC

Table of content: MRS. EILEEN MCDONALD LENNOX N.P., B.C. (NPI 1871580928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720422959 NPI number — TRANSITIONAL ALTERNATIVE REENTRY INITIATIVE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANSITIONAL ALTERNATIVE REENTRY INITIATIVE, INC
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:
1720422959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 673
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60507-0673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-264-0700
Provider Business Mailing Address Fax Number:
630-264-0701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
635 N ELMWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60506-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-264-0700
Provider Business Practice Location Address Fax Number:
630-264-0701
Provider Enumeration Date:
04/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KNAZZE
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
GERARD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-264-0700

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  A54450002A , 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)





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