1568441145 NPI number — LCM HOME HEALTH EQUIPMENT CENTER

Table of content: (NPI 1568441145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568441145 NPI number — LCM HOME HEALTH EQUIPMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LCM HOME HEALTH EQUIPMENT CENTER
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:
1568441145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5610 W 95 ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-499-0071
Provider Business Mailing Address Fax Number:
708-499-4415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5610 W 95 ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-499-0071
Provider Business Practice Location Address Fax Number:
708-499-4415
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
708-499-0071

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56647 . This is a "NATIONAL PROVIDER NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: L016420 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 131626700 . This is a "US DEPTARTMENT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1670691 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 455642 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 56647 . This is a "DMENSION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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