Provider Demographics
NPI:1043574825
Name:COORDINATED CARE ALLIANCE
Entity Type:Organization
Organization Name:COORDINATED CARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HABUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-535-8380
Mailing Address - Street 1:101 S GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-6407
Mailing Address - Country:US
Mailing Address - Phone:224-535-8380
Mailing Address - Fax:224-535-9028
Practice Address - Street 1:101 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-6407
Practice Address - Country:US
Practice Address - Phone:224-535-8083
Practice Address - Fax:224-535-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management