Provider Demographics
NPI:1063513109
Name:RESURRECTION SERVICES
Entity type:Organization
Organization Name:RESURRECTION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLUPPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-568-8524
Mailing Address - Street 1:5747 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3056
Mailing Address - Country:US
Mailing Address - Phone:847-568-8542
Mailing Address - Fax:847-568-8635
Practice Address - Street 1:5747 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3056
Practice Address - Country:US
Practice Address - Phone:847-568-8542
Practice Address - Fax:847-568-8635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESURRECTION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010210251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health