Provider Demographics
NPI:1457655664
Name:FAMILY HEALTH PREVENTION & CARE CENTER
Entity Type:Organization
Organization Name:FAMILY HEALTH PREVENTION & CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-947-8306
Mailing Address - Street 1:1020 N. MILWAUKEE AVE.,
Mailing Address - Street 2:STE 160
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 NORTH MILWAUKEE AVENUE,
Practice Address - Street 2:SUIT 160
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015
Practice Address - Country:US
Practice Address - Phone:847-947-8306
Practice Address - Fax:847-890-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental