Provider Demographics
NPI:1366082232
Name:WESTCARE ILLINOIS, INC
Entity type:Organization
Organization Name:WESTCARE ILLINOIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CERINICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-568-7051
Mailing Address - Street 1:1100 W CERMAK RD # B414
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4500
Mailing Address - Country:US
Mailing Address - Phone:312-568-7051
Mailing Address - Fax:312-243-4107
Practice Address - Street 1:1100 W CERMAK RD STE B116
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4540
Practice Address - Country:US
Practice Address - Phone:312-568-7051
Practice Address - Fax:312-243-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health