Provider Demographics
NPI:1083072839
Name:SUNOVA HEALTHCARE S.C.
Entity Type:Organization
Organization Name:SUNOVA HEALTHCARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGAER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPACZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-559-5091
Mailing Address - Street 1:1480 RENAISSANCE DR STE 211
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1353
Mailing Address - Country:US
Mailing Address - Phone:847-559-9015
Mailing Address - Fax:847-296-6262
Practice Address - Street 1:1420 RENAISSANCE DR STE 207
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1342
Practice Address - Country:US
Practice Address - Phone:847-559-9015
Practice Address - Fax:847-574-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361000942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty