Provider Demographics
NPI:1528194263
Name:HOWE CENTER - 4461
Entity Type:Organization
Organization Name:HOWE CENTER - 4461
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-614-3515
Mailing Address - Street 1:7600 183RD ST
Mailing Address - Street 2:UNIT 4461
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3690
Mailing Address - Country:US
Mailing Address - Phone:708-614-3515
Mailing Address - Fax:708-532-7289
Practice Address - Street 1:7600 183RD ST
Practice Address - Street 2:UNIT 4461
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3690
Practice Address - Country:US
Practice Address - Phone:708-614-3515
Practice Address - Fax:708-532-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6009666251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000984461001Medicaid