Provider Demographics
NPI:1497215933
Name:ACTIVATE HEALTHCARE
Entity Type:Organization
Organization Name:ACTIVATE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-248-8592
Mailing Address - Street 1:2010 N DAMEN AVE UNIT F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3286
Mailing Address - Country:US
Mailing Address - Phone:708-669-0430
Mailing Address - Fax:
Practice Address - Street 1:2010 N DAMEN AVE UNIT F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3286
Practice Address - Country:US
Practice Address - Phone:708-669-0430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVATE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty