Organization Name: | SERTOMA CENTRE, INC. |
NPI Number: | 1306170592 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GUS VAN DEN BRINK (EXECUTIVE DIRECTOR) |
Mailing Address: | 4100 W 127th St Alsip |
State: | IL US |
Postal Code: | 608031925 |
Phone Number: | 7083719700 |
Fax Number: | 7083719700 |
NPI Enumeration Date: | 09/22/2009 |
NPI Last Update Date: | 09/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251V00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Voluntary or Charitable |
Taxonomy Specialization: | |
Taxonomy Definition: |