Provider Demographics
NPI:1043050420
Name:LILAC HEALTH PLLC
Entity type:Organization
Organization Name:LILAC HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORKORM
Authorized Official - Suffix:
Authorized Official - Credentials:APN, FNP-C, PMHNP-BC
Authorized Official - Phone:815-919-4890
Mailing Address - Street 1:992 BROOK FOREST AVE # 1039
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8807
Mailing Address - Country:US
Mailing Address - Phone:815-919-4890
Mailing Address - Fax:877-483-9684
Practice Address - Street 1:1913 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586
Practice Address - Country:US
Practice Address - Phone:815-919-4890
Practice Address - Fax:877-483-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty