Organization
TRI-CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY DENISE PORTER (EXECUTIVE DIRECTOR)
(773) 375-6146
Entity
Organization
Contact information
Practice address
9208 S COLFAX AVE, CHICAGO, IL 60617-4029
(773) 375-6146
(773) 375-6148
Mailing address
9208 S COLFAX AVE, CHICAGO, IL 60617-4029
(773) 375-6146
(773) 375-6148
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
20020006C
IL
Other
Enumeration date
04/20/2007
Last updated
12/18/2015
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