Healthcare Provider Details

I. General information

NPI: 1083031249
Provider Name (Legal Business Name): MEDTEC HEALTHCARE & PRIVATE DUTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 W DUNDEE RD
WHEELING IL
60090
US

IV. Provider business mailing address

47 W DUNDEE RD STE 2SW
WHEELING IL
60090-4866
US

V. Phone/Fax

Practice location:
  • Phone: 847-229-1088
  • Fax: 847-470-4289
Mailing address:
  • Phone: 847-229-8200
  • Fax: 847-229-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YI WONG
Title or Position: VICE PRESIDENT
Credential:
Phone: 847-663-5511