Healthcare Provider Details

I. General information

NPI: 1477181782
Provider Name (Legal Business Name): EMBASSY STUDIOS NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6455 N CICERO AVE
LINCOLNWOOD IL
60712-3407
US

IV. Provider business mailing address

6455 N CICERO AVE
LINCOLNWOOD IL
60712-3407
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-0330
  • Fax:
Mailing address:
  • Phone: 847-675-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JOSEPHINE RANSFORD
Title or Position: PRESIDENT
Credential:
Phone: 847-675-0330