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General NPI Number Information
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NPI Number | 1942476957
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Entity Type | Organization
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Legal Business Name | HEALTH MAINTENANCE INSITITUE OF ILLINOIS, INC.
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 2604 E DEMPSTER ST STE 402
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City | PARK RIDGE
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State | IL
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Zip | 60068-8438
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Country | US
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Telephone | 847-635-6580
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Fax | 847-635-0038
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Provider Business Mailing Address
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Address Line | 2604 E DEMPSTER ST STE 402
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City | PARK RIDGE
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State | IL
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Zip | 60068-8438
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Country | US
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Telephone | 847-635-6580
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Fax | 847-635-0038
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KATHY KYE
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Credential | CHES
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Telephone | 847-635-6580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 036044591
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License Number State | IL
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