Provider Demographics
NPI:1760896369
Name:ACCOUNTABLE CARE CHICAGO
Entity Type:Organization
Organization Name:ACCOUNTABLE CARE CHICAGO
Other - Org Name:MYCARE CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-8200
Mailing Address - Street 1:5145 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3661
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-878-6152
Practice Address - Street 1:5145 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3661
Practice Address - Country:US
Practice Address - Phone:773-878-8200
Practice Address - Fax:773-878-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL078Medicaid