Healthcare Provider Details

I. General information

NPI: 1932459393
Provider Name (Legal Business Name): HEROES HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 W 111TH STREET
CHICAGO IL
60655-2205
US

IV. Provider business mailing address

3139 W 111TH STREET
CHICAGO IL
60655-2205
US

V. Phone/Fax

Practice location:
  • Phone: 312-944-4653
  • Fax: 312-944-0747
Mailing address:
  • Phone: 312-944-4653
  • Fax: 312-944-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SARGON BENJAMIN ODISHO
Title or Position: OWNER
Credential: D.C.
Phone: 773-805-9517