Provider Demographics
NPI:1285771758
Name:TYRRELL-LOPEZ, INC
Entity type:Organization
Organization Name:TYRRELL-LOPEZ, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:630-244-2080
Mailing Address - Street 1:931 W 75TH ST
Mailing Address - Street 2:137302
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1294
Mailing Address - Country:US
Mailing Address - Phone:630-946-0166
Mailing Address - Fax:630-946-0170
Practice Address - Street 1:4219 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1294
Practice Address - Country:US
Practice Address - Phone:630-946-0166
Practice Address - Fax:630-946-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010188251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364470331001OtherDSCC MEDICAID
IL381674OtherPROVIDER REFERENCE DHFS
IL147593Medicare ID - Type UnspecifiedMEDICARE NUMBER