Healthcare Provider Details

I. General information

NPI: 1124896741
Provider Name (Legal Business Name): AURORA FUNCTIONAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 E NEW YORK ST
AURORA IL
60504-4465
US

IV. Provider business mailing address

3535 E NEW YORK ST
AURORA IL
60504-4465
US

V. Phone/Fax

Practice location:
  • Phone: 214-764-2706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD IRFAN ALY
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 214-764-2706