1932442571 NPI number — LAYNIE FOUNDATION

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 1932442571 NPI number — LAYNIE FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAYNIE FOUNDATION
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:
1932442571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4747 LINCOLN MALL DR
Provider Second Line Business Mailing Address:
SUITE 604
Provider Business Mailing Address City Name:
MATTESON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60443-3811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-617-8548
Provider Business Mailing Address Fax Number:
708-617-8017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 LINCOLN MALL DR
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
MATTESON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60443-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-617-8548
Provider Business Practice Location Address Fax Number:
708-617-8017
Provider Enumeration Date:
04/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MATHESON
Authorized Official First Name:
SUMMER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
C.O.O.
Authorized Official Telephone Number:
708-617-8548

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1790076628 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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