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General NPI Number Information
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NPI Number | 1275281792
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Entity Type | Organization
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Legal Business Name | RACING INDUSTRY CHARITABLE FOUNDATION
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 3701 S LARAMIE AVE
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City | CICERO
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State | IL
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Zip | 60804-4513
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Country | US
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Telephone | 708-343-9375
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Fax | 708-652-3084
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Provider Business Mailing Address
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Address Line | 3501 S LARAMIE AVE
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City | CICERO
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State | IL
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Zip | 60804-4503
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Country | US
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Telephone | 708-343-9375
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Fax | 708-652-3084
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PAUL CORONADO
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Credential |
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Telephone | 708-343-9375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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