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General NPI Number Information
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NPI Number | 1891339487
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Entity Type | Organization
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Legal Business Name | VANGUARD ELDERCARE MEDICAL GROUP - ILLINOIS SC
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 12600 RENAISSANCE CIR
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City | HOMER GLEN
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State | IL
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Zip | 60491-5891
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | 2100 N MAIN ST STE 301 ONE PROFESSIONAL CENTER
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City | CROWN POINT
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State | IN
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Zip | 46307-1877
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN L POSAR
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Credential |
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Telephone | 574-546-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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