1194194175 NPI number — COMPASSION CILA HOMES INC,

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 1194194175 NPI number — COMPASSION CILA HOMES INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSION CILA HOMES 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:
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:
1194194175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 SPRINGFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60466-1145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-419-2211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 SPRINGFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK FOREST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60466-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-419-2211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BASSEY
Authorized Official First Name:
FREDA
Authorized Official Middle Name:
BENJAMIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
773-419-2211

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  201500006C , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 201500006C , 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)