Provider Demographics
NPI:1891214730
Name:SOUTHLAND CARE COORDINATION PARTNERS, INC.
Entity Type:Organization
Organization Name:SOUTHLAND CARE COORDINATION PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLERKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-996-4000
Mailing Address - Street 1:600 HOLIDAY PLAZA DR STE 230
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3094
Mailing Address - Country:US
Mailing Address - Phone:708-996-4000
Mailing Address - Fax:708-898-0142
Practice Address - Street 1:600 HOLIDAY PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3094
Practice Address - Country:US
Practice Address - Phone:708-996-4000
Practice Address - Fax:708-898-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management