Provider Demographics
NPI:1205170164
Name:733 BEACH WALK, INC.
Entity type:Organization
Organization Name:733 BEACH WALK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-800-3837
Mailing Address - Street 1:113 FAIRFIELD WAY
Mailing Address - Street 2:SUITE 106C
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1587
Mailing Address - Country:US
Mailing Address - Phone:630-800-3837
Mailing Address - Fax:630-344-0867
Practice Address - Street 1:113 FAIRFIELD WAY
Practice Address - Street 2:SUITE 106C
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1587
Practice Address - Country:US
Practice Address - Phone:630-800-3837
Practice Address - Fax:630-344-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000538253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care