| Heartsource Therapy Pc | |
|
33 E Colorado Ave Frankfort IL 60423-1385 | |
| (708) 837-3319 | |
| (815) 469-6481 |
| Full Name | Heartsource Therapy Pc |
|---|---|
| Speciality | Social Worker |
| Location | 33 E Colorado Ave, Frankfort, Illinois |
| Authorized Official Name and Position | Gale Nienhuis (PRESIDENT) |
| Authorized Official Contact | 7088373319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heartsource Therapy Pc Po Box 523 Orland Park IL 60462-0523 Ph: (708) 837-3319 | Heartsource Therapy Pc 33 E Colorado Ave Frankfort IL 60423-1385 Ph: (708) 837-3319 |
| NPI Number | 1215314414 |
|---|---|
| Provider Enumeration Date | 04/27/2015 |
| Last Update Date | 04/27/2015 |
| Medicare PECOS PAC ID | 2860711603 |
|---|---|
| Medicare Enrollment ID | O20150429001733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215314414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149014484 (Illinois) | Primary |
| Provider Name | Gale E Nienhuis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104043181 PECOS PAC ID: 5193986057 Enrollment ID: I20120419000765 |
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