Provider Demographics
NPI:1134573306
Name:FRONTIER HEALTHCARE SYSTEMS OF ILLINOIS
Entity type:Organization
Organization Name:FRONTIER HEALTHCARE SYSTEMS OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LETASHA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-283-4011
Mailing Address - Street 1:900 OGDEN AVE # 335
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2829
Mailing Address - Country:US
Mailing Address - Phone:732-340-3887
Mailing Address - Fax:773-234-0394
Practice Address - Street 1:8741 S GREENWOOD SUITE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619
Practice Address - Country:US
Practice Address - Phone:732-340-3887
Practice Address - Fax:773-234-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL81119538OtherEIN