Healthcare Provider Details

I. General information

NPI: 1407077969
Provider Name (Legal Business Name): EL VALOR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 W 19TH ST
CHICAGO IL
60608-2647
US

IV. Provider business mailing address

1850 W 21ST ST
CHICAGO IL
60608-2715
US

V. Phone/Fax

Practice location:
  • Phone: 312-997-2021
  • Fax: 312-432-9849
Mailing address:
  • Phone: 312-492-5930
  • Fax: 312-666-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAN OVERSTREET
Title or Position: VICE PRESIDENT FISCAL OPERATIONS
Credential:
Phone: 312-492-5930