Provider Demographics
NPI:1568724086
Name:ILLINOIS COORDINATED CARE PARTNERSHIP, LLC
Entity Type:Organization
Organization Name:ILLINOIS COORDINATED CARE PARTNERSHIP, LLC
Other - Org Name:ICCP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:312-554-0600
Mailing Address - Street 1:1359 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1905
Mailing Address - Country:US
Mailing Address - Phone:312-554-0600
Mailing Address - Fax:312-554-8161
Practice Address - Street 1:1359 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1905
Practice Address - Country:US
Practice Address - Phone:312-554-0600
Practice Address - Fax:312-554-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4549088621251B00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health