Provider Demographics
NPI:1639128200
Name:EMPLOYEE HEALTH ADVOCATE LTD
Entity Type:Organization
Organization Name:EMPLOYEE HEALTH ADVOCATE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RASHEED
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-358-7468
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-0074
Mailing Address - Country:US
Mailing Address - Phone:847-358-7468
Mailing Address - Fax:847-358-2808
Practice Address - Street 1:26241 W BONNER RD
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-3211
Practice Address - Country:US
Practice Address - Phone:847-358-7468
Practice Address - Fax:847-358-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND712108Medicare PIN
IN247340Medicare PIN
PA1923634Medicare PIN
WY20820Medicare PIN
KYFLU0296Medicare PIN
OHFV94661Medicare PIN
KS130666Medicare PIN
AZ109720Medicare PIN
ORR135167Medicare PIN
TN3914414Medicare PIN
WA8860782Medicare PIN