1184632051 NPI number — GREENVIEW HEALTH CENTER CHARTERED

Table of content: (NPI 1184632051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184632051 NPI number — GREENVIEW HEALTH CENTER CHARTERED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENVIEW HEALTH CENTER CHARTERED
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:
1184632051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-0120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-334-9056
Provider Business Mailing Address Fax Number:
773-334-9009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5025 N PAULINA AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640-2772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-334-9056
Provider Business Practice Location Address Fax Number:
773-334-9009
Provider Enumeration Date:
08/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OJEA
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
ADALBERTO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-334-9056

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036061009 , 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: 010012601 . This is a "MED RR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036061009 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003160120 . This is a "BCBC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".