1104515121 NPI number — GERIATRIC CARE NP ASSOCIATES

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 1104515121 NPI number — GERIATRIC CARE NP ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRIC CARE NP ASSOCIATES
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:
1104515121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2515 WAUKEGAN RD
Provider Second Line Business Mailing Address:
PMB 10002
Provider Business Mailing Address City Name:
BANNOCKBURN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-655-5040
Provider Business Mailing Address Fax Number:
484-218-4920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2515 WAUKEGAN RD
Provider Second Line Business Practice Location Address:
PMB 10002
Provider Business Practice Location Address City Name:
BANNOCKBURN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-655-5040
Provider Business Practice Location Address Fax Number:
484-218-4920
Provider Enumeration Date:
05/04/2023

Additional Information

Authorized Official

Authorized Official Last Name:
TOBIN
Authorized Official First Name:
BRITTANY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-655-5040

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com