Provider Demographics
NPI:1104291434
Name:SANTOS NATURAL HEALTH CENTER
Entity type:Organization
Organization Name:SANTOS NATURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:HUSNI
Authorized Official - Last Name:KHALIFEH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:630-670-8351
Mailing Address - Street 1:6905 CERMAK RD STE B
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2175
Mailing Address - Country:US
Mailing Address - Phone:708-317-4240
Mailing Address - Fax:
Practice Address - Street 1:6905 CERMAK RD STE B
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2175
Practice Address - Country:US
Practice Address - Phone:708-317-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001280302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization