Provider Demographics
NPI:1134944754
Name:1103 HEALTH PARTNERS, LLC
Entity type:Organization
Organization Name:1103 HEALTH PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-433-5650
Mailing Address - Street 1:47 INDIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3939
Mailing Address - Country:US
Mailing Address - Phone:301-272-0203
Mailing Address - Fax:
Practice Address - Street 1:265 EXCHANGE DR STE 105
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6230
Practice Address - Country:US
Practice Address - Phone:847-433-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1103 HEALTH PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based