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General NPI Number Information
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NPI Number | 1922836170
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Entity Type | Organization
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Legal Business Name | FORT CARE, LLC
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 11/03/2024
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Provider Practice Location Address
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Address Line | 18241 WEST ST STE 209
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City | LANSING
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State | IL
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Zip | 60438-3200
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Country | US
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Telephone | 800-897-4575
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Fax | 800-306-9509
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Provider Business Mailing Address
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Address Line | 18241 WEST ST STE 209
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City | LANSING
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State | IL
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Zip | 60438-3200
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Country | US
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Telephone | 800-897-4575
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Fax | 800-306-9509
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Authorized Official
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Title or Position | CEO/PROVIDER
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Name | MS. LATEISHA NICOLE FORT
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Credential | APRN-FPA
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Telephone | 708-668-6971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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