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General NPI Number Information
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NPI Number | 1760966675
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Entity Type | Organization
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Legal Business Name | ILLINOIS HEALTH PRACTICE ALLIANCE, LLC
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 77 W WACKER DR STE 1200
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City | CHICAGO
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State | IL
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Zip | 60601-1712
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Country | US
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Telephone | 312-619-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 77 W WACKER DR STE 1200
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City | CHICAGO
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State | IL
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Zip | 60601-1712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DAVID M BERKEY
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Credential |
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Telephone | 312-619-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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