Provider Demographics
NPI:1861242042
Name:MEDICAID SUPPORT, LLC
Entity type:Organization
Organization Name:MEDICAID SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YISRAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEHUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-512-3579
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60011-0517
Mailing Address - Country:US
Mailing Address - Phone:877-512-3579
Mailing Address - Fax:866-578-1828
Practice Address - Street 1:21660 W FIELD PKWY
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:IL
Practice Address - Zip Code:60010-7265
Practice Address - Country:US
Practice Address - Phone:847-512-3579
Practice Address - Fax:866-578-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management