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NPI Code Detail

MEDICARE: JOSHUA ALLIED HOME HEALTH CORPORATION NFP

MEDICARE: JOSHUA ALLIED HOME HEALTH CORPORATION NFP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1336547488
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOSHUA ALLIED HOME HEALTH CORPORATION NFP
Provider Business Mailing Address
First Line : 4250 N MARINE DR APT 2534
Second Line :
City : CHICAGO
State : IL
Zip : 60613-1741
Country : US
Telephone Number : 773-458-7527
Fax Number :
Provider Business Practice Location Address
First Line : 4250 N MARINE DR APT 2534
Second Line :
City : CHICAGO
State : IL
Zip : 60613-1741
Country : US
Telephone Number : 773-458-7527
Fax Number :
Authorized Official
Title or Position : PRESIDENT/DIRECTOR
Name : GERVASE BOLDEN
Credential :
Telephone Number : 773-458-7527
Provider Enumeration Date : 12/05/2014
Last Update Date : 12/05/2014

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Directions to “JOSHUA ALLIED HOME HEALTH CORPORATION NFP ” Practice Location

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