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General NPI Number Information
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NPI Number | 1073807707
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Entity Type | Organization
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Legal Business Name | LR HEALTH MANAGEMENT, INC
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Dates
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Enumeration Date | 05/28/2011
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Last Update Date | 05/28/2011
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Provider Practice Location Address
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Address Line | 1204 S 57TH AVE
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City | CICERO
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State | IL
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Zip | 60804-1148
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Country | US
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Telephone | 312-375-7145
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Fax | 708-652-5424
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Provider Business Mailing Address
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Address Line | 1204 S 57TH AVE
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City | CICERO
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State | IL
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Zip | 60804-1148
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Country | US
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Telephone | 312-375-7145
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Fax | 708-652-5424
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. DIVINEGRACE LABAO
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Credential |
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Telephone | 312-375-7145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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