Healthcare Provider Details

I. General information

NPI: 1528848439
Provider Name (Legal Business Name): GLAM HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W DEVON AVE STE 106
CHICAGO IL
60659-1216
US

IV. Provider business mailing address

3601 W DEVON AVE STE 106
CHICAGO IL
60659-1216
US

V. Phone/Fax

Practice location:
  • Phone: 131-282-5247
  • Fax:
Mailing address:
  • Phone: 131-282-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LILLA DIRISU
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 312-825-2477