Provider Demographics
NPI:1467053306
Name:ACUTE MANTIS CARE
Entity Type:Organization
Organization Name:ACUTE MANTIS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-541-1826
Mailing Address - Street 1:6050 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3916
Mailing Address - Country:US
Mailing Address - Phone:312-809-0777
Mailing Address - Fax:847-675-6092
Practice Address - Street 1:7800 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3124
Practice Address - Country:US
Practice Address - Phone:312-809-0777
Practice Address - Fax:773-492-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center