Healthcare Provider Details

I. General information

NPI: 1154901783
Provider Name (Legal Business Name): AT YOUR DOOR PHYSICIAN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 S EMERALD AVE
CHICAGO IL
60621-2953
US

IV. Provider business mailing address

5525 S EMERALD AVE
CHICAGO IL
60621-2953
US

V. Phone/Fax

Practice location:
  • Phone: 312-636-3722
  • Fax:
Mailing address:
  • Phone: 312-636-3722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TARYRSHA DAVIS
Title or Position: NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 312-636-3722