# GERIATRIC PSYCHIATRIC SERVICES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306172788
- **Authorized official:** MR. ROBERT CLEMENTE (MANAGER)
- **Authorized official phone:** (847) 519-3650

## Contact information

- **Practice address:** 445 S COUNTY ROAD 525 E, AVON, IN 46123-8361
- **Practice address phone:** (317) 745-2522
- **Mailing address:** 1721 MOON LAKE BLVD, SUITE 150, HOFFMAN ESTATES, IL 60169-1069
- **Mailing address phone:** (847) 519-3650
- **Mailing address fax:** (847) 519-3652

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 10/20/2009
- **Last updated:** 10/20/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | IN260860 | MEDICARE PTAN | IN |