Organization
COMMUNITY NEUROLOGIC CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BORIS LAKE (BUSINESS MANAGER)
(630) 208-7735
Entity
Organization
Contact information
Practice address
2172 BLACKBERRY DRIVE, SUITE 202, GENEVA, IL 60134-2577
(630) 208-7735
(630) 208-6956
Mailing address
2172 BLACKBERRY DRIVE, SUITE 202, GENEVA, IL 60134-2577
(630) 208-7735
(630) 208-6956
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.000950
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093008
—
IL
Enumeration date
01/04/2008
Last updated
04/02/2008
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