Healthcare Provider Details
I. General information
NPI: 1649959636
Provider Name (Legal Business Name): RCI (WRS), INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2400 N SHEFFIELD AVE
CHICAGO IL
60614-3936
US
IV. Provider business mailing address
4714 GETTYSBURG RD
MECHANICSBURG PA
17055-4325
US
V. Phone/Fax
- Phone: 773-389-2201
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QX0100X |
| Taxonomy | Occupational Medicine Clinic/Center |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MICHAEL
TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100