Provider Demographics
NPI:1952859332
Name:AMERICAN HOME AMBULATORY CARE CENTER,LLC
Entity Type:Organization
Organization Name:AMERICAN HOME AMBULATORY CARE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-930-4538
Mailing Address - Street 1:601 W GOLF RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 W GOLF RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4276
Practice Address - Country:US
Practice Address - Phone:773-930-4538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HOME CIRCLE OF CARE MANAGER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center