Provider Demographics
NPI:1184757353
Name:TCA HEALTH INC NFP
Entity type:Organization
Organization Name:TCA HEALTH INC NFP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-995-6300
Mailing Address - Street 1:1029 E 130TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-6908
Mailing Address - Country:US
Mailing Address - Phone:773-995-6300
Mailing Address - Fax:773-995-7985
Practice Address - Street 1:1029 E 130TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-6908
Practice Address - Country:US
Practice Address - Phone:773-995-6300
Practice Address - Fax:773-995-7985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TCA HEALTH INC NFP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid