Provider Demographics
NPI:1588094502
Name:IRVING URBAN DEVELOPMENT
Entity type:Organization
Organization Name:IRVING URBAN DEVELOPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CICELY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-557-9492
Mailing Address - Street 1:739 N AUSTIN BLVD # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-1004
Mailing Address - Country:US
Mailing Address - Phone:773-969-8945
Mailing Address - Fax:
Practice Address - Street 1:739 N AUSTIN BLVD # 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-1004
Practice Address - Country:US
Practice Address - Phone:773-969-8945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health