Healthcare Provider Details

I. General information

NPI: 1801727458
Provider Name (Legal Business Name): SUPPORTIVE SERVICES AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S WACKER DR
CHICAGO IL
60606-7147
US

IV. Provider business mailing address

233 S WACKER DR
CHICAGO IL
60606-7147
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-8277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TESHANN COAKLEY
Title or Position: OWNER
Credential: RN-BSN
Phone: 312-600-8277