1811378623 NPI number — FINS HEALTHCARE AGENCY

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 1811378623 NPI number — FINS HEALTHCARE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FINS HEALTHCARE AGENCY
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:
1811378623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3612 LINCOHN HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 19
Provider Business Mailing Address City Name:
OLYMPIA FIELDS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-612-1144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3612 LINCOHN HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
OLYMPIA FIELDS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-571-3467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLAOYE
Authorized Official First Name:
IDAYAT
Authorized Official Middle Name:
ABIMBOLA
Authorized Official Title or Position:
CHIEF EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
708-612-1144

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  2015-N1341 , 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)