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General NPI Number Information
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NPI Number | 1629318258
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Entity Type | Organization
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Legal Business Name | HEALTHCARE CONSORTIUM OF ILLINOIS
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 1350 E. SIBLEY BLVD.
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City | DOLTON
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State | IL
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Zip | 60419-2966
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Country | US
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Telephone | 708-841-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 E. SIBLEY BLVD.
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City | DOLTON
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State | IL
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Zip | 60419
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Country | US
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Telephone | 708-841-9515
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Fax | 708-841-9681
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Authorized Official
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Title or Position | CEO
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Name | MR. SALIM AL NURRIDIN
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Credential |
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Telephone | 708-841-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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