Healthcare Provider Details

I. General information

NPI: 1144803438
Provider Name (Legal Business Name): 4D CARE ASSIST FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MICHIGAN AVE, SUITE 1740
CHICAGO IL
60611
US

IV. Provider business mailing address

401 N MICHIGAN AVE, SUITE 1740
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 224-633-9472
  • Fax: 630-857-9069
Mailing address:
  • Phone: 224-633-9472
  • Fax: 630-857-9069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: NIKKI ORTH
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 847-309-4874