Healthcare Provider Details

I. General information

NPI: 1093404576
Provider Name (Legal Business Name): TCA HEALTH INC NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 12/03/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 HOHMAN AVE
HAMMOND IN
46320-1933
US

IV. Provider business mailing address

1029 E 130TH ST
CHICAGO IL
60628-6908
US

V. Phone/Fax

Practice location:
  • Phone: 773-995-6300
  • Fax: 773-995-7985
Mailing address:
  • Phone: 773-995-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VERONICA CLARKE
Title or Position: CEO
Credential:
Phone: 773-995-1940