Provider Demographics
NPI:1518323195
Name:PROHEALTH PREVENTION LLC
Entity Type:Organization
Organization Name:PROHEALTH PREVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-993-7992
Mailing Address - Street 1:1943 S MAY ST
Mailing Address - Street 2:1F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3359
Mailing Address - Country:US
Mailing Address - Phone:312-549-8866
Mailing Address - Fax:312-549-8861
Practice Address - Street 1:1943 S MAY ST
Practice Address - Street 2:1F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3359
Practice Address - Country:US
Practice Address - Phone:312-549-8866
Practice Address - Fax:312-549-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203002034Medicaid