Healthcare Provider Details

I. General information

NPI: 1235241720
Provider Name (Legal Business Name): SERTOMA CENTRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W 123RD ST
ALSIP IL
60803-1807
US

IV. Provider business mailing address

4343 W 123RD ST
ALSIP IL
60803-1807
US

V. Phone/Fax

Practice location:
  • Phone: 708-371-9700
  • Fax: 708-371-9747
Mailing address:
  • Phone: 708-371-9700
  • Fax: 708-371-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GUS VAN DEN BRINK
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 708-371-9700