| NPI | 1699182642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELSA MONTOTO VEGA Lcsw 773-550-3143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: IL 149.015412) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: IL 149.015412) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |