Provider Demographics
NPI:1053622043
Name:CARVER MILITARY ACADEMY
Entity type:Organization
Organization Name:CARVER MILITARY ACADEMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-928-5090
Mailing Address - Street 1:1029 E 130TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-6908
Mailing Address - Country:US
Mailing Address - Phone:773-995-6300
Mailing Address - Fax:773-995-7985
Practice Address - Street 1:13100 S DOTY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60827-1597
Practice Address - Country:US
Practice Address - Phone:773-535-5357
Practice Address - Fax:773-995-7985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TCA HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-24
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)