1023002326 NPI number — RESURRECTION SENIOR SERVICES

Table of content: (NPI 1023002326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023002326 NPI number — RESURRECTION SENIOR SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESURRECTION SENIOR SERVICES
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:
1023002326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N RIVER RD
Provider Second Line Business Mailing Address:
FINANCE DIVISION, 2ND FLOOR
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60016-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-813-3722
Provider Business Mailing Address Fax Number:
847-813-3785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2380 E DEMPSTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60016-4839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-296-3335
Provider Business Practice Location Address Fax Number:
847-296-2659
Provider Enumeration Date:
09/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAPOBIANCO
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT FINANCE
Authorized Official Telephone Number:
847-813-3707

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0026286 , 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: 789 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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