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General NPI Number Information
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NPI Number | 1669247250
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Entity Type | Organization
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Legal Business Name | HAH CARE COORDINATION ILLINOIS LLC
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Dates
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Enumeration Date | 11/24/2023
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 33 S STATE STREET FIFTH FLOOR, SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60603-2804
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Country | US
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Telephone | 773-339-8812
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Fax | 833-341-5692
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Provider Business Mailing Address
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Address Line | 33 S STATE STREET FIFTH FLOOR, SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60603-2804
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Country | US
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Telephone | 773-339-8812
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Fax |
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Authorized Official
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Title or Position | CHIEF LEGAL OFFICER
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Name | MR. JOSEPH BONACCORSI
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Credential |
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Telephone | 312-346-6599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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