Organization Name: | SOLID ROCK CARE CENTER II |
NPI Number: | 1780877993 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY SMITH (CEO) |
Mailing Address: | 228 Madison St Oak Park |
State: | IL US |
Postal Code: | 603024194 |
Phone Number: | 7083588040 |
Fax Number: | 7083588049 |
NPI Enumeration Date: | 08/21/2007 |
NPI Last Update Date: | 08/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |