Healthcare Provider Details

I. General information

NPI: 1114698578
Provider Name (Legal Business Name): ULTRA HOME HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N CICERO AVE STE 309
CHICAGO IL
60646-5719
US

IV. Provider business mailing address

5901 N CICERO AVE STE 205
CHICAGO IL
60646-5718
US

V. Phone/Fax

Practice location:
  • Phone: 773-657-3728
  • Fax: 773-492-7456
Mailing address:
  • Phone: 773-657-3728
  • Fax: 773-492-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. OMOLOLA ASIELUE
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-657-3728