Provider Demographics
NPI:1215398573
Name:FAMILY HEALTH PARTNERSHIP
Entity Type:Organization
Organization Name:FAMILY HEALTH PARTNERSHIP
Other - Org Name:FAMILY HEALTH PARTNERSHIP CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:779-220-9315
Mailing Address - Street 1:401 E CONGRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6210
Mailing Address - Country:US
Mailing Address - Phone:779-220-9300
Mailing Address - Fax:
Practice Address - Street 1:401 E CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6210
Practice Address - Country:US
Practice Address - Phone:779-220-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health