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General NPI Number Information
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NPI Number | 1023434891
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Entity Type | Organization
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Legal Business Name | MEDTEC HEALTHCARE & PRIVATE DUTY, LLC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 4834 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-3704
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Country | US
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Telephone | 773-293-0111
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Fax | 773-293-0112
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Provider Business Mailing Address
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Address Line | 4834 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60640-3704
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Country | US
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Telephone | 773-293-0111
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Fax | 773-293-0112
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | YI WONG
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Credential |
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Telephone | 847-663-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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