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Organization
GERIATRIC PSYCHIATRIC SERVICES PLLC
Active
Organization
GERIATRIC PSYCHIATRIC SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT CLEMENTE (MANAGER)
(847) 519-3650
Entity
Organization
Contact information
Practice address
445 S COUNTY ROAD 525 E, AVON, IN 46123-8361
(317) 745-2522
Mailing address
1721 MOON LAKE BLVD, SUITE 150, HOFFMAN ESTATES, IL 60169-1069
(847) 519-3650
(847) 519-3652
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN260860
MEDICARE PTAN
IN
Enumeration date
10/20/2009
Last updated
10/20/2009
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