1922154780 NPI number — CENTER FOR FAMILY HEALTH CARE, S.C.

Table of content: (NPI 1922154780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922154780 NPI number — CENTER FOR FAMILY HEALTH CARE, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR FAMILY HEALTH CARE, S.C.
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:
1922154780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 E IRVING PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOOD DALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60191-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-385-0700
Provider Business Mailing Address Fax Number:
877-550-1717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 E IRVING PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOOD DALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60191-3985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-385-0700
Provider Business Practice Location Address Fax Number:
877-550-1717
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
VERA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
847-385-0700

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  042005492 , 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: 16-17248 . This is a "BC BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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