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General NPI Number Information
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NPI Number | 1134573306
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Entity Type | Organization
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Legal Business Name | FRONTIER HEALTHCARE SYSTEMS OF ILLINOIS
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 8741 S GREENWOOD SUITE 102
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City | CHICAGO
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State | IL
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Zip | 60619
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Country | US
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Telephone | 732-340-3887
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Fax | 773-234-0394
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Provider Business Mailing Address
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Address Line | 900 OGDEN AVE # 335
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2829
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Country | US
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Telephone | 732-340-3887
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Fax | 773-234-0394
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Authorized Official
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Title or Position | CEO
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Name | LETASHA Y. LEWIS
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Credential |
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Telephone | 901-283-4011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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