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General NPI Number Information
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NPI Number | 1902293657
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Entity Type | Organization
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Legal Business Name | TWO HARBORS INTEGRATIVE HEALTHCARE, LLC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 2220 MARQUETTE RD
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City | PERU
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State | IL
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Zip | 61354-1555
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Country | US
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Telephone | 815-343-0771
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Fax | 888-303-1960
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | SHEFFIELD
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State | IL
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Zip | 61361-0014
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Country | US
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Telephone | 815-343-0771
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Fax | 888-303-1960
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE A CHRISTENSEN
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Credential |
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Telephone | 815-343-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 209.001386
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License Number State | IL
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