Provider Demographics
NPI:1023434891
Name:MEDTEC HEALTHCARE & PRIVATE DUTY, LLC
Entity type:Organization
Organization Name:MEDTEC HEALTHCARE & PRIVATE DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YI
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-663-5511
Mailing Address - Street 1:4834 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3704
Mailing Address - Country:US
Mailing Address - Phone:773-293-0111
Mailing Address - Fax:773-293-0112
Practice Address - Street 1:4834 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3704
Practice Address - Country:US
Practice Address - Phone:773-293-0111
Practice Address - Fax:773-293-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care