Provider Demographics
NPI:1699112102
Name:DIRECT CARE WELLNESS, LLC
Entity type:Organization
Organization Name:DIRECT CARE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-562-0840
Mailing Address - Street 1:3100 DUNDEE RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2437
Mailing Address - Country:US
Mailing Address - Phone:847-562-0840
Mailing Address - Fax:847-562-0842
Practice Address - Street 1:3100 DUNDEE RD
Practice Address - Street 2:SUITE 504
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2437
Practice Address - Country:US
Practice Address - Phone:847-562-0840
Practice Address - Fax:847-562-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007974111N00000X
IL036092369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK38767Medicare PIN