Provider Demographics
NPI:1972827111
Name:SUPPLEMENTAL HEALTH CARE
Entity type:Organization
Organization Name:SUPPLEMENTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:312-498-2637
Mailing Address - Street 1:4902 PINE CONE CT
Mailing Address - Street 2:APT 1
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-6215
Mailing Address - Country:US
Mailing Address - Phone:312-498-2637
Mailing Address - Fax:
Practice Address - Street 1:222 S RIVERSIDE PLZ
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5808
Practice Address - Country:US
Practice Address - Phone:866-386-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007520310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility