Provider Demographics
NPI:1598094344
Name:AMERICAN FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:AMERICAN FAMILY HEALTHCARE LLC
Other - Org Name:AMERICAN FAMILY HEALTHCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLYCROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:217-446-1100
Mailing Address - Street 1:715 W FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3795
Mailing Address - Country:US
Mailing Address - Phone:217-446-1100
Mailing Address - Fax:217-446-1101
Practice Address - Street 1:715 W FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3795
Practice Address - Country:US
Practice Address - Phone:217-446-1100
Practice Address - Fax:217-446-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty