Provider Demographics
NPI:1902023096
Name:GARDEN CENTER SERVICES
Entity Type:Organization
Organization Name:GARDEN CENTER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCOUNTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-941-4151
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 1:8333 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2558
Practice Address - Country:US
Practice Address - Phone:708-636-0054
Practice Address - Fax:708-636-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
IL36103315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001Medicaid
14G251OtherMEDICARE