Healthcare Provider Details

I. General information

NPI: 1508580911
Provider Name (Legal Business Name): CONRAD CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 W PETERSON AVE STE 505
CHICAGO IL
60659-3317
US

IV. Provider business mailing address

3525 W PETERSON AVE STE 505
CHICAGO IL
60659-3317
US

V. Phone/Fax

Practice location:
  • Phone: 131-220-4725
  • Fax:
Mailing address:
  • Phone: 131-220-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS EFOSA AGBONIFO
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-240-9225