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General NPI Number Information
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NPI Number | 1013638832
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Entity Type | Organization
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Legal Business Name | MED-ADVO-C LLC
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 1505 YORKSHIRE CT
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City | JOLIET
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State | IL
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Zip | 60431-8088
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Country | US
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Telephone | 708-972-9715
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Fax | 630-326-3382
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Provider Business Mailing Address
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Address Line | 1505 YORKSHIRE CT
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City | JOLIET
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State | IL
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Zip | 60431-8088
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Country | US
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Telephone | 708-972-0915
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Fax | 630-326-3382
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Authorized Official
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Title or Position | CEO/OWNER
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Name | APRIL MCMURRAY-WHITE
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Credential |
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Telephone | 708-972-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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