Provider Demographics
NPI:1508805938
Name:COMPREHENSIVE QUALITY CARE INC FOUNDATION
Entity Type:Organization
Organization Name:COMPREHENSIVE QUALITY CARE INC FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT &CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-924-5900
Mailing Address - Street 1:3517 SOUTH MARTIN LUTHER KING DR.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653
Mailing Address - Country:UM
Mailing Address - Phone:773-924-5900
Mailing Address - Fax:773-924-5933
Practice Address - Street 1:3517 S KING DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3395
Practice Address - Country:US
Practice Address - Phone:773-924-5900
Practice Address - Fax:773-924-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010238251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364435038001Medicaid
IL364435038001Medicaid