Organization · Type 2 NPI
Grand Victorian of Sycamore, LLC
Point of Service · Sycamore, IL
NPI number
1154527810
Active
Practice location
1440 Somonauk St
Sycamore, IL 60178-2916
Fax (815) 895-1901
Mailing address
78 Centennial Loop
Eugene, OR 97401-7900
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Point of Service Primary | 305S00000X | None listed |
Point of Service: This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost.
Another provider at this address
About NPI 1154527810
Grand Victorian of Sycamore, LLC's National Provider Identifier is 1154527810, issued on Jun 21, 2007. The primary taxonomy on file is Point of Service (305S00000X), and the practice location is in Sycamore, IL. The record was last updated on May 13, 2008.