Provider Demographics
NPI:1528271582
Name:LESTER AND ROSALIE ANIXTER CENTER
Entity type:Organization
Organization Name:LESTER AND ROSALIE ANIXTER CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-761-1501
Mailing Address - Street 1:6610 N CLARK ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4062
Mailing Address - Country:US
Mailing Address - Phone:773-761-1501
Mailing Address - Fax:773-977-1240
Practice Address - Street 1:2001 N CLYBOURN AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4036
Practice Address - Country:US
Practice Address - Phone:773-761-1501
Practice Address - Fax:773-977-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209504Medicare PIN