Healthcare Provider Details

I. General information

NPI: 1962743666
Provider Name (Legal Business Name): WHITE CRANE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 W FOSTER AVE
CHICAGO IL
60640-2013
US

IV. Provider business mailing address

1657 W FOSTER AVE
CHICAGO IL
60640-2013
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-9001
  • Fax: 773-271-9231
Mailing address:
  • Phone: 773-271-9001
  • Fax: 773-271-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberCERT IL. DEPT AGING
License Number StateIL

VIII. Authorized Official

Name: ELIZABETH ANN CAGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-271-9001