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General NPI Number Information
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NPI Number | 1962407361
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Entity Type | Organization
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Legal Business Name | WILSON CARE, INC.
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4544 N HAZEL ST
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City | CHICAGO
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State | IL
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Zip | 60640-5716
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Country | US
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Telephone | 773-561-7241
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Fax | 773-728-2606
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Provider Business Mailing Address
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Address Line | 4100 W PRATT AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3517
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Country | US
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Telephone | 847-674-5200
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Fax | 847-674-5267
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Authorized Official
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Title or Position | TREASURER
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Name | MR. THOMAS WINTER
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Credential | CPA
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Telephone | 847-674-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 0029975
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License Number State | IL
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