| Phoenix Family Center, Llc | |
|
474 Summit St Elgin IL 60120 | |
| (847) 224-1256 | |
| Not Available |
| Full Name | Phoenix Family Center, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 474 Summit St, Elgin, Illinois |
| Authorized Official Name and Position | Michelle Potter (C0-OWNER) |
| Authorized Official Contact | 2245359555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Family Center, Llc 474 Summit St Elgin IL 60120-3829 Ph: (847) 224-1256 | Phoenix Family Center, Llc 474 Summit St Elgin IL 60120 Ph: (847) 224-1256 |
| NPI Number | 1467872820 |
|---|---|
| Provider Enumeration Date | 04/23/2014 |
| Last Update Date | 07/21/2022 |
| Certification Date | 02/23/2021 |
| Medicare PECOS PAC ID | 9537424098 |
|---|---|
| Medicare Enrollment ID | O20180604001699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467872820 | NPI | - | NPPES |
| Provider Name | Katie L Hazek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043519275 PECOS PAC ID: 3274776935 Enrollment ID: I20130827000918 |
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