Provider Demographics
NPI:1457376253
Name:ALL FAMILY HEALTH CARE INC
Entity Type:Organization
Organization Name:ALL FAMILY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-775-2588
Mailing Address - Street 1:6413 N KINZUA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2853
Mailing Address - Country:US
Mailing Address - Phone:773-775-2588
Mailing Address - Fax:773-775-1283
Practice Address - Street 1:6413 N KINZUA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2853
Practice Address - Country:US
Practice Address - Phone:773-775-2588
Practice Address - Fax:773-775-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010286251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
147783OtherMEDICARE PTAN
IL147783Medicare UPIN