Provider Demographics
NPI:1780863811
Name:BERWYN TOWNSHIP PUBLIC HEALTH DISTRICT
Entity Type:Organization
Organization Name:BERWYN TOWNSHIP PUBLIC HEALTH DISTRICT
Other - Org Name:BERWYN PUBLIC HEALTH DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, BERWYN TOWNSHIP PUBLIC H
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PECHOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-788-6600
Mailing Address - Street 1:6600 W. 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2652
Mailing Address - Country:US
Mailing Address - Phone:708-788-6600
Mailing Address - Fax:708-788-0432
Practice Address - Street 1:6600 W. 26TH STREET
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2652
Practice Address - Country:US
Practice Address - Phone:708-788-6600
Practice Address - Fax:708-788-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068028251K00000X
IL14D0993141251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203-249Medicare PIN