1811230014 NPI number — JENCARE NEIGHBORHOOD MEDICAL CENTER BERWYN, LLC

Table of content: (NPI 1811230014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811230014 NPI number — JENCARE NEIGHBORHOOD MEDICAL CENTER BERWYN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENCARE NEIGHBORHOOD MEDICAL CENTER BERWYN, LLC
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:
1811230014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1395 NW 167TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33169-5710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-628-6117
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6326 CERMAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-628-6117
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
305-831-4722

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  036.131322 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332900000X , with the licence number: 036.131322 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com