Organization
FRONTIER HEALTHCARE SYSTEMS OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETASHA Y. LEWIS (CEO)
(901) 283-4011
Entity
Organization
Contact information
Practice address
8741 S GREENWOOD SUITE 102, CHICAGO, IL 60619
(732) 340-3887
(773) 234-0394
Mailing address
900 OGDEN AVE # 335, DOWNERS GROVE, IL 60515-2829
(732) 340-3887
(773) 234-0394
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81119538
EIN
IL
Enumeration date
04/14/2016
Last updated
08/23/2022
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