Diversey Health Care Clinic Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036.120095 Issued in IL

Legal business name

DIVERSEY HEALTH CARE CLINIC INC

Doing business as

Diversey HealthCare Clinic

Practice address

4911 W Diversey Ave
Chicago, IL 60639-1705

Phone

(773) 237-3100

Fax

(855) 299-4948

NPI assigned

May 11, 2015

Last updated

Aug 21, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ricardo Machado, M.D

Title

President

Phone

(708) 738-7351

Specialties & licenses 1

Addresses

Other names 1

• Diversey HealthCare Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1225416308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "349 BUCKINGHAM CT",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601481667",
            "telephone_number": "708-738-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4911 W DIVERSEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391705",
            "telephone_number": "773-237-3100",
            "fax_number": "855-299-4948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSEY HEALTH CARE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "MACHADO",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-738-7351",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036.120095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversey HealthCare Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diversey Medical Center SC
• Diversfied Emergency Services, LLC
• Diversified Behavioral Services
• Diversified Behavioral Services, Inc.
• Diversified Home Care Inc (Safe Life Home Healthcare Chicago)

• Primary Care Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.