Healthcare Provider Details

I. General information

NPI: 1376651703
Provider Name (Legal Business Name): GERIATRIC CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 OAKMONT LN
WESTMONT IL
60559-3700
US

IV. Provider business mailing address

PO BOX 869
LA GRANGE IL
60525-0869
US

V. Phone/Fax

Practice location:
  • Phone: 630-321-1115
  • Fax: 630-321-1116
Mailing address:
  • Phone: 630-321-1115
  • Fax: 630-321-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEHRDAD ABBASSIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-667-1142