Healthcare Provider Details

I. General information

NPI: 1235519513
Provider Name (Legal Business Name): VUE PROCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 N HAMLIN AVE
CHICAGO IL
60625-5703
US

IV. Provider business mailing address

4611 N HAMLIN AVE
CHICAGO IL
60625-5703
US

V. Phone/Fax

Practice location:
  • Phone: 773-495-2814
  • Fax:
Mailing address:
  • Phone: 773-495-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. DANIELLA ROYSTER
Title or Position: DIRECTOR
Credential:
Phone: 773-495-2814