Provider Demographics
NPI:1235676362
Name:PREVENTATIVE HEALTH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PREVENTATIVE HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-419-1884
Mailing Address - Street 1:6650 N NORTHWEST HWY
Mailing Address - Street 2:304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1307
Mailing Address - Country:US
Mailing Address - Phone:773-732-0762
Mailing Address - Fax:
Practice Address - Street 1:6650 N NORTHWEST HWY
Practice Address - Street 2:304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1307
Practice Address - Country:US
Practice Address - Phone:773-732-0762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041334818163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty