Provider Demographics
NPI:1659700458
Name:ADVANCED CARE OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:ADVANCED CARE OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BODIE
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:APN, FNP
Authorized Official - Phone:847-840-1900
Mailing Address - Street 1:21251 N CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2986
Mailing Address - Country:US
Mailing Address - Phone:847-840-1900
Mailing Address - Fax:847-382-6352
Practice Address - Street 1:21251 N CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2986
Practice Address - Country:US
Practice Address - Phone:847-840-1900
Practice Address - Fax:847-382-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309002422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty