Provider Demographics
NPI:1386830040
Name:HEAL-THY PEOPLE FAMILY CARE CENTER LTD
Entity Type:Organization
Organization Name:HEAL-THY PEOPLE FAMILY CARE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVERNE
Authorized Official - Middle Name:MONISE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:773-551-3246
Mailing Address - Street 1:6030 COLGATE LN
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1995
Mailing Address - Country:US
Mailing Address - Phone:708-720-5161
Mailing Address - Fax:708-720-5162
Practice Address - Street 1:2813 W 147TH ST
Practice Address - Street 2:
Practice Address - City:POSEN
Practice Address - State:IL
Practice Address - Zip Code:60469
Practice Address - Country:US
Practice Address - Phone:708-396-9777
Practice Address - Fax:708-720-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110716261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI51090Medicare UPIN