| Organization Name: | THE BREAKERS AT EDGEWATER BEACH |
| NPI Number: | 1275826455 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHERIE DUPOR (DIRECTOR OF SALES AND MARKETING) |
| Mailing Address: | 5333 N Sheridan Rd Chicago |
| State: | IL US |
| Postal Code: | 606407371 |
| Phone Number: | 7738785333 |
| Fax Number: | |
| NPI Enumeration Date: | 05/23/2011 |
| NPI Last Update Date: | 05/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251F00000X |
| License Number: | 36381847 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Home Infusion |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |