1801802012 NPI number — CARE CENTERS HEALTH SYSTEMS LIMITED

Table of content: (NPI 1801802012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801802012 NPI number — CARE CENTERS HEALTH SYSTEMS LIMITED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE CENTERS HEALTH SYSTEMS LIMITED
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:
1801802012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HOWARD AVE
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-612-5662
Provider Business Mailing Address Fax Number:
224-612-5862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 HOWARD AVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60018-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-612-5662
Provider Business Practice Location Address Fax Number:
224-612-5862
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRONER
Authorized Official First Name:
YISHAI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
224-612-5680

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  203.00378 , 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)

  • Identifier: 0241503 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 363874609001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01625203 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200199080A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2211681 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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