1780740209 NPI number — EMBASSY HOLDINGS LLC

Table of content: (NPI 1780740209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780740209 NPI number — EMBASSY HOLDINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBASSY HOLDINGS 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:
EMBASSY HEALTH CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1780740209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7520 SKOKIE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60077-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-329-8450
Provider Business Mailing Address Fax Number:
847-329-8453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W KAHLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60481-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-476-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANDEL
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
847-329-8450

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1786501 , 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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