Provider Demographics
NPI:1316136278
Name:ERICKSON RETIREMENT COMMUNITIES, LLC
Entity type:Organization
Organization Name:ERICKSON RETIREMENT COMMUNITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE HEALTH MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-402-2261
Mailing Address - Street 1:701 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5968
Mailing Address - Country:US
Mailing Address - Phone:410-402-2261
Mailing Address - Fax:410-402-2264
Practice Address - Street 1:2255 ERICKSON DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4164
Practice Address - Country:US
Practice Address - Phone:630-300-1126
Practice Address - Fax:630-300-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty