Provider Demographics
NPI:1649359969
Name:ELGIN CARE CENTER SC
Entity type:Organization
Organization Name:ELGIN CARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:VELOSO
Authorized Official - Last Name:FLORENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:847-695-4800
Mailing Address - Street 1:530 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-3275
Mailing Address - Country:US
Mailing Address - Phone:847-695-4800
Mailing Address - Fax:847-695-4820
Practice Address - Street 1:530 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-3275
Practice Address - Country:US
Practice Address - Phone:847-695-4800
Practice Address - Fax:847-695-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL588930Medicare ID - Type Unspecified
F46615Medicare UPIN