Healthcare Provider Details

I. General information

NPI: 1316136278
Provider Name (Legal Business Name): ERICKSON RETIREMENT COMMUNITIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 ERICKSON DR
NAPERVILLE IL
60563-4164
US

IV. Provider business mailing address

701 MAIDEN CHOICE LN
BALTIMORE MD
21228-5968
US

V. Phone/Fax

Practice location:
  • Phone: 630-300-1126
  • Fax: 630-300-1394
Mailing address:
  • Phone: 410-402-2261
  • Fax: 410-402-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRAIG DAVID THORNE
Title or Position: EMPLOYEE HEALTH MEDICAL DIRECTOR
Credential: MD
Phone: 410-402-2261