Provider Demographics
NPI:1982917712
Name:PROFESSIONAL CARE TEAM CORPORATION
Entity Type:Organization
Organization Name:PROFESSIONAL CARE TEAM CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-203-4356
Mailing Address - Street 1:855 E GOLF RD
Mailing Address - Street 2:SUITE 2138
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5222
Mailing Address - Country:US
Mailing Address - Phone:847-483-8890
Mailing Address - Fax:847-594-4292
Practice Address - Street 1:855 E GOLF RD
Practice Address - Street 2:SUITE 2138
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5222
Practice Address - Country:US
Practice Address - Phone:847-483-8890
Practice Address - Fax:847-594-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011169251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health