Healthcare Provider Details

I. General information

NPI: 1427963875
Provider Name (Legal Business Name): SIPS, SALADS & SOUL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7263 S EXCHANGE AVE
CHICAGO IL
60649-2533
US

IV. Provider business mailing address

1050 E 95TH ST
CHICAGO IL
60619-7828
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-0043
  • Fax:
Mailing address:
  • Phone: 312-600-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: SHAQUITA M BOOKER
Title or Position: OWNER
Credential:
Phone: 708-668-3277