1053368613 NPI number — FRANCISCAN COMMUNITIES, INC.

Table of content: (NPI 1053368613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053368613 NPI number — FRANCISCAN COMMUNITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCAN COMMUNITIES, 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:
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:
1053368613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 175TH ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60430-4610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-647-6500
Provider Business Mailing Address Fax Number:
708-647-6982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 ARMORY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELPHI
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46923-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-564-6380
Provider Business Practice Location Address Fax Number:
765-564-6384
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
SR. VP/CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
708-647-6500

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  05-000187-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100267300C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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