=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306105374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O&N CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2012
-----------------------------------------------------
Last Update Date | 05/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6225 S KENWOOD AVE APT 1S
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60637-3766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-808-4360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6225 S KENWOOD AVE APT #1S
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-808-4360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. NASTANE LE BEC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 773-808-4360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------