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General NPI Number Information
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NPI Number | 1760647846
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Entity Type | Organization
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Legal Business Name | GARDEN CENTER SERVICES
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 3309 HARVEY AVE
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City | BERWYN
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State | IL
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Zip | 60402-3807
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Country | US
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Telephone | 708-398-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 8333 AUSTIN AVE
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City | BURBANK
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State | IL
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Zip | 60459-2558
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Country | US
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Telephone | 708-636-0054
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Fax | 708-636-7955
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GERARD S. BEAGLES
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Credential |
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Telephone | 708-636-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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