MEDICARE: NEIGHBORHOOD HEALTH GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1619236072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD HEALTH GROUP, LLC

Provider Business Mailing Address
First Line	:	5860 W HIGGINS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5860 W HIGGINS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2372
Country	:	US
Telephone Number	:	773-695-4800
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. PAUL GHILARDI
Credential	:
Telephone Number	:	773-695-4800

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	05/04/2012

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