Healthcare Provider Details

I. General information

NPI: 1285158295
Provider Name (Legal Business Name): WINDY CITY LIMOUSINE COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S 25TH AVE
BROADVIEW IL
60155-4531
US

IV. Provider business mailing address

2801 S 25TH AVE
BROADVIEW IL
60155-4531
US

V. Phone/Fax

Practice location:
  • Phone: 847-916-9300
  • Fax:
Mailing address:
  • Phone: 847-916-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. JEROLD BEAN
Title or Position: DIRECTOR OF SALES
Credential:
Phone: 847-916-9244