Healthcare Provider Details

I. General information

NPI: 1285397935
Provider Name (Legal Business Name): COOL CROWN HEALTH CARE SERVICES LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 W PETERSON AVE STE 222
CHICAGO IL
60659-3314
US

IV. Provider business mailing address

3525 W PETERSON AVE STE 222
CHICAGO IL
60659-3314
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-7752
  • Fax:
Mailing address:
  • Phone: 773-293-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FLORENCE ADEBIYI
Title or Position: AGENCY MANAGER
Credential:
Phone: 773-293-7752