1386830040 NPI number — HEAL-THY PEOPLE FAMILY CARE CENTER LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386830040 NPI number — HEAL-THY PEOPLE FAMILY CARE CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAL-THY PEOPLE FAMILY CARE CENTER LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386830040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6030 COLGATE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTESON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60443-1995
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-720-5161
Provider Business Mailing Address Fax Number:
708-720-5162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2813 W 147TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POSEN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-396-9777
Provider Business Practice Location Address Fax Number:
708-720-5162
Provider Enumeration Date:
09/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
LAVERNE
Authorized Official Middle Name:
MONISE
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
773-551-3246

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  036110716 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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