1386826733 NPI number — FAMILY WELLNESS & HEALTHCARE, LLC.

Table of content: (NPI 1386826733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386826733 NPI number — FAMILY WELLNESS & HEALTHCARE, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY WELLNESS & HEALTHCARE, LLC.
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:
1386826733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10289 W LINCOLN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60423-1279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-464-9655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10289 W LINCOLN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60423-1279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-464-9655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA-BEACH
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
815-464-9655

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036-085569 , 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: 2022817945 . This is a "MULTIPLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2022817945 . This is a "UNICARE PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2022817945 . This is a "INTERPLAN/PREFERRED PLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 12650 . This is a "HFN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 212254 . This is a "MEDICARE ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 776241 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 09932351 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4398541 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2022817945 . This is a "UNITED HEALTHCARE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8025898 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9395998 . This is a "PHCS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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