Healthcare Provider Details

I. General information

NPI: 1508562851
Provider Name (Legal Business Name): CONTRACT NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 S SOUTH SHORE DR APT 406
CHICAGO IL
60649-2751
US

IV. Provider business mailing address

7220 S SOUTH SHORE DR APT 406
CHICAGO IL
60649-2751
US

V. Phone/Fax

Practice location:
  • Phone: 312-774-5315
  • Fax:
Mailing address:
  • Phone: 312-774-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MAURICE PUOMAAYE KONTA
Title or Position: MANAGER
Credential: RN-MSN
Phone: 131-277-4531