Healthcare Provider Details

I. General information

NPI: 1932566023
Provider Name (Legal Business Name): WINDYCITYWHEELCHAIRSERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6427 S PARNELL AVE
CHICAGO IL
60621
US

IV. Provider business mailing address

6427 S PARNELL AVE
CHICAGO IL
60621-2719
US

V. Phone/Fax

Practice location:
  • Phone: 773-420-3087
  • Fax:
Mailing address:
  • Phone: 773-420-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberD14140416
License Number StateIL

VIII. Authorized Official

Name: MAURICE REEVES
Title or Position: CEO
Credential:
Phone: 773-420-3087