| Fort Care, Llc | |
|
18241 West St Ste 209 Lansing IL 60438-3200 | |
| (800) 897-4575 | |
| (800) 306-9509 |
| Full Name | Fort Care, Llc |
|---|---|
| Speciality | Clinical Medical Laboratory |
| Location | 18241 West St Ste 209, Lansing, Illinois |
| Authorized Official Name and Position | Lateisha Nicole Fort (CEO/PROVIDER) |
| Authorized Official Contact | 7086686971 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Care, Llc 18241 West St Ste 209 Lansing IL 60438-3200 Ph: (800) 897-4575 | Fort Care, Llc 18241 West St Ste 209 Lansing IL 60438-3200 Ph: (800) 897-4575 |
| NPI Number | 1922836170 |
|---|---|
| Provider Enumeration Date | 07/22/2024 |
| Last Update Date | 11/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922836170 | NPI | - | NPPES |
| 248004959 | Other | IL | DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATIONS |
| 14D2284487 | Other | IL | CMS CLIA CERTIFICATE OF WAIVER |
| 1841906047 | Other | IL | GROUP NPI |
| 1275024523 | Other | IL | PRIMARY PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Primary |
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Fort Care, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 18241 West St Ste 209, Lansing, IL 60438 Phone: 800-897-4575 Fax: 800-306-9509 |