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General NPI Number Information
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NPI Number | 1205170164
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Entity Type | Organization
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Legal Business Name | 733 BEACH WALK, INC.
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 113 FAIRFIELD WAY SUITE 106C
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1587
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Country | US
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Telephone | 630-800-3837
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Fax | 630-344-0867
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Provider Business Mailing Address
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Address Line | 113 FAIRFIELD WAY SUITE 106C
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1587
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Country | US
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Telephone | 630-800-3837
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Fax | 630-344-0867
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | MR. CHRIS GERARDI
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Credential |
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Telephone | 630-800-3837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000538
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License Number State | IL
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