Provider Demographics
NPI:1265502728
Name:MOBILE CARE FOUNDATION
Entity Type:Organization
Organization Name:MOBILE CARE FOUNDATION
Other - Org Name:MOBILE CARE CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-254-4030
Mailing Address - Street 1:239 W ROOT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-2848
Mailing Address - Country:US
Mailing Address - Phone:773-254-4030
Mailing Address - Fax:
Practice Address - Street 1:239 W ROOT ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-2848
Practice Address - Country:US
Practice Address - Phone:773-254-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090394Medicaid
IL01635798OtherBCBS