Healthcare Provider Details

I. General information

NPI: 1013447085
Provider Name (Legal Business Name): JES-ROYAL HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/21/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 S PRINCETON AVE FL 1
CHICAGO IL
60609-4544
US

IV. Provider business mailing address

4747 S PRINCETON AVE FL 1
CHICAGO IL
60609-4544
US

V. Phone/Fax

Practice location:
  • Phone: 773-501-5690
  • Fax:
Mailing address:
  • Phone: 773-501-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ABIODUN AJAYI
Title or Position: CEO
Credential:
Phone: 773-470-7944