Provider Demographics
NPI:1881054757
Name:STATEWIDE AGENCY
Entity type:Organization
Organization Name:STATEWIDE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAK
Authorized Official - Middle Name:I
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-724-3600
Mailing Address - Street 1:1920 WAUKEGAN ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-724-3600
Mailing Address - Fax:847-241-0202
Practice Address - Street 1:1920 WAUKEGAN RD
Practice Address - Street 2:SUITE 5
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1717
Practice Address - Country:US
Practice Address - Phone:847-724-3600
Practice Address - Fax:847-241-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL100287909251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage