Provider Demographics
NPI:1699092429
Name:FAMILY HOME CARE PHYSICIANS LLC
Entity type:Organization
Organization Name:FAMILY HOME CARE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-833-2412
Mailing Address - Street 1:6956 155TH PL
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1599
Mailing Address - Country:US
Mailing Address - Phone:708-833-2412
Mailing Address - Fax:708-961-2028
Practice Address - Street 1:6956 155TH PL
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1599
Practice Address - Country:US
Practice Address - Phone:708-833-2412
Practice Address - Fax:708-961-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty