Organization Active NPI

Sertoma Centre, Inc.

  • Voluntary or Charitable Agency
  • Alsip, IL
National Provider Identifier
1306170592
Registry record updated Sep 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Voluntary or Charitable AgencyTaxonomy code 251V00000X
Legal business name
SERTOMA CENTRE, INC.
Practice address
4100 W 127TH St
Alsip, IL 60803-1925
Phone
(708) 371-9700
Fax
(708) 371-9700
NPI assigned
Sep 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2009

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

Authorized official

Name
Mr. Gus Van Den Brink, LCSW
Title
Executive Director
Phone
(708) 371-9700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Voluntary or Charitable Agency 251V00000X Primary

Addresses

Primary practice location

4100 W 127TH St
Alsip, IL 60803-1925

Mailing address

4343 W 123Rd St
Alsip, IL 60803-1807
Phone (708) 371-9700

National Provider Directory

National Provider Directory
Tax ID family
Sertoma Centre Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253577600000",
    "number": "1306170592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 W 123RD ST",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608031807",
            "telephone_number": "708-371-9700",
            "fax_number": "708-371-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 W 127TH ST",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608031925",
            "telephone_number": "708-371-9700",
            "fax_number": "708-371-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERTOMA CENTRE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-22",
        "last_updated": "2009-09-22",
        "status": "A",
        "authorized_official_last_name": "VAN DEN BRINK",
        "authorized_official_first_name": "GUS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-371-9700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alsip, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2009; 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.