Provider Demographics
NPI:1629168638
Name:ABINGTON OUTPATIENT CENTER LLC
Entity Type:Organization
Organization Name:ABINGTON OUTPATIENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:SUAREZ
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:847-729-0000
Mailing Address - Street 1:3901 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2467
Mailing Address - Country:US
Mailing Address - Phone:847-729-0000
Mailing Address - Fax:847-729-1552
Practice Address - Street 1:3901 GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2467
Practice Address - Country:US
Practice Address - Phone:847-729-0000
Practice Address - Fax:847-729-1552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLEN RIDGE ASSOCIATES II LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2152672OtherUNITED HEALTHCARE
IL363621644OtherCIGNA
IL1548374465OtherAETNA
IL1630123OtherBCBS
IL363621644OtherHUMANA
IL1630123OtherBCBS