Organization · NPI-2

7739956300

Social Worker, Clinical · Chicago, IL

NPI number1336685494
StatusActive
Last updated in NPPESJan 13, 2017

Details

NPI
1336685494
Entity type
Organization (NPI-2)
Legal business name
7739956300
Organization subpart
No
Enumeration date
Jan 13, 2017
Last updated
Jan 13, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, Clinical149018713ILYes

Other names

  • Tca Health Care (Former Legal Business Name)

Practice location

1029 E 130th St
Chicago, IL 60628-6908

Phone 773-995-6300 · Fax 773-995-6192

Mailing address

1029 E.130th Street
Chicago, IL 60628

Phone 773-995-6300 · Fax 773-995-6192

Authorized official

Marquetta D Hall
Billing Coding Specialist
7739956300

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