Provider Demographics
NPI:1962767038
Name:WIN U CARE FOR HEALTH
Entity type:Organization
Organization Name:WIN U CARE FOR HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIETECHNISIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED
Authorized Official - Phone:618-741-8012
Mailing Address - Street 1:321 BIG ARCH RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035
Mailing Address - Country:US
Mailing Address - Phone:618-741-8012
Mailing Address - Fax:618-374-6297
Practice Address - Street 1:321 BIG ARCH RD.
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035
Practice Address - Country:US
Practice Address - Phone:618-741-8012
Practice Address - Fax:618-374-6297
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIA L PHILLIPS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1790049831Medicaid