Provider Demographics
NPI:1235336868
Name:WEST SUBURBAN SENIOR SERVICES
Entity Type:Organization
Organization Name:WEST SUBURBAN SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRONET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-547-5600
Mailing Address - Street 1:439 BOHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-1833
Mailing Address - Country:US
Mailing Address - Phone:708-547-5600
Mailing Address - Fax:
Practice Address - Street 1:439 BOHLAND AVE
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-1833
Practice Address - Country:US
Practice Address - Phone:708-547-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL975960Medicare ID - Type Unspecified