Organization
IN HOME COUNSELING FOR SENIORS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELSA MONTOTO VEGA (LCSW)
(773) 550-3143
Entity
Organization
Contact information
Practice address
2318 N LOWELL AVE, CHICAGO, IL 60639-3520
(773) 550-3143
Mailing address
2318 N LOWELL AVE, CHICAGO, IL 60639-3520
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
149.015412
IL
305S00000X
Point of Service
149.015412
IL
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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