Organization Name: | HEALTH HEROES OF ILLINOIS, INC. |
NPI Number: | 1588054100 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SANDRA DI SALVO (PRESIDENT) |
Mailing Address: | 3412 Office Park Dr Marion |
State: | IL US |
Postal Code: | 629596477 |
Phone Number: | 2564265389 |
Fax Number: | |
NPI Enumeration Date: | 02/03/2015 |
NPI Last Update Date: | 02/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036110081 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |