Provider Demographics
NPI:1972087369
Name:INTEGRATED HEALTHCARE CHICAGO LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING OPERATING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-497-9947
Mailing Address - Street 1:1044 N FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2743
Mailing Address - Country:US
Mailing Address - Phone:773-292-8339
Mailing Address - Fax:
Practice Address - Street 1:1044 N FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2743
Practice Address - Country:US
Practice Address - Phone:773-292-8339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNONEOtherINTEGRATED HEALTH HOME