1801802012 NPI number — CARE CENTERS HEALTH SYSTEMS LIMITED

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 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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