Provider Demographics
NPI:1730192022
Name:TAKE CARE HEALTH ILLINOIS, P.C.
Entity type:Organization
Organization Name:TAKE CARE HEALTH ILLINOIS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-709-2469
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS 640
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:855-925-4733
Mailing Address - Fax:217-709-2345
Practice Address - Street 1:3 EAST GOLF ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:217-709-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216185Medicare PIN
IL214217Medicare PIN
IL214219Medicare PIN
IL214218Medicare PIN