Provider Demographics
NPI:1184241903
Name:SAJ FAMILY PRACTICE HEALTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SAJ FAMILY PRACTICE HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYCHE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:708-673-4604
Mailing Address - Street 1:3687 MELANIE LN
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1615
Mailing Address - Country:US
Mailing Address - Phone:708-860-0957
Mailing Address - Fax:
Practice Address - Street 1:19730 GOVERNORS HWY STE 6
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2083
Practice Address - Country:US
Practice Address - Phone:708-673-4604
Practice Address - Fax:833-974-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center