Provider Demographics
NPI:1619365061
Name:HAVANA HEALTH,LLC
Entity Type:Organization
Organization Name:HAVANA HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:815-714-2517
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5261
Mailing Address - Country:US
Mailing Address - Phone:815-714-2517
Mailing Address - Fax:815-714-2719
Practice Address - Street 1:3033 W JEFFERSON ST
Practice Address - Street 2:STE. 201
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5261
Practice Address - Country:US
Practice Address - Phone:815-714-2517
Practice Address - Fax:815-714-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1243892083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty