1114088226 NPI number — HEALTH OPTIONS OF IL, INC

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 1114088226 NPI number — HEALTH OPTIONS OF IL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH OPTIONS OF IL, INC
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:
1114088226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4415 W. HARRISON STREET
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
HILLSIDE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-432-4000
Provider Business Mailing Address Fax Number:
708-432-4078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4415 W. HARRISON STREET
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
HILLSIDE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-432-4000
Provider Business Practice Location Address Fax Number:
708-432-4078
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THAIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF BOARD
Authorized Official Telephone Number:
847-395-1560

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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