Provider Demographics
NPI:1275281792
Name:RACING INDUSTRY CHARITABLE FOUNDATION
Entity Type:Organization
Organization Name:RACING INDUSTRY CHARITABLE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-343-9375
Mailing Address - Street 1:3501 S LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4503
Mailing Address - Country:US
Mailing Address - Phone:708-343-9375
Mailing Address - Fax:708-652-3084
Practice Address - Street 1:3701 S LARAMIE AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4513
Practice Address - Country:US
Practice Address - Phone:708-343-9375
Practice Address - Fax:708-652-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health