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General NPI Number Information
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NPI Number | 1700132917
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR RECERTIFICATION INC
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 808 S POPLAR AVE
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City | ELMHURST
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State | IL
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Zip | 60126-4543
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Country | US
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Telephone | 630-291-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 808 S POPLAR AVE
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City | ELMHURST
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State | IL
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Zip | 60126-4543
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Country | US
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Telephone | 630-291-0636
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN FREDERICK GILLS
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Credential | PH.D.
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Telephone | 630-291-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | D62195762
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License Number State | IL
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