Provider Demographics
NPI:1073822037
Name:ILLINICARE HEALTH PLAN, INC.
Entity Type:Organization
Organization Name:ILLINICARE HEALTH PLAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-329-4701
Mailing Address - Street 1:999 OAKMONT PLAZA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5516
Mailing Address - Country:US
Mailing Address - Phone:866-329-4701
Mailing Address - Fax:
Practice Address - Street 1:999 OAKMONT PLAZA DR STE 400
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5516
Practice Address - Country:US
Practice Address - Phone:866-329-4701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTENE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-24
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization