Provider Demographics
NPI:1760647846
Name:GARDEN CENTER SERVICES
Entity Type:Organization
Organization Name:GARDEN CENTER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEAGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-636-0054
Mailing Address - Street 1:8333 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2558
Mailing Address - Country:US
Mailing Address - Phone:708-636-0054
Mailing Address - Fax:708-636-7955
Practice Address - Street 1:3309 HARVEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3807
Practice Address - Country:US
Practice Address - Phone:708-398-6560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid