1740683812 NPI number — ECUMENICAL SUPPORT SERVICES FOR THE ELDERLY ESSE CENTER

Table of content: (NPI 1740683812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740683812 NPI number — ECUMENICAL SUPPORT SERVICES FOR THE ELDERLY ESSE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECUMENICAL SUPPORT SERVICES FOR THE ELDERLY ESSE 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:
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:
1740683812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 N PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ELLYN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60137-5713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-260-3773
Provider Business Mailing Address Fax Number:
630-260-8046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5110 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-656-5870
Provider Business Practice Location Address Fax Number:
847-672-4836
Provider Enumeration Date:
10/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIT
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
630-260-3773

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  ADS1202005 , 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)





Copyright © 2007-2025 www.npivalidator.com