# LCR PRIMARY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588037873
- **Authorized official:** MS. LORETTA B. JOHNSON C.N.A. (OWNER)
- **Authorized official phone:** (773) 431-1508

## Contact information

- **Practice address:** 9237 S.PULASKI, STE. 2S, EVERGREEN PARK, IL 60805
- **Practice address phone:** (773) 431-1508
- **Mailing address:** 9237 S PULASKI RD, STE 2S, EVERGREEN PARK, IL 60805-1454
- **Mailing address phone:** (773) 431-1508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 302F00000X | IL | Yes |

## Other

- **Enumeration date:** 11/09/2015
- **Last updated:** 11/09/2015