Healthcare Provider Details

I. General information

NPI: 1790419646
Provider Name (Legal Business Name): GLOMAST HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 S DEARBORN ST
CHICAGO IL
60609-2910
US

IV. Provider business mailing address

4341 S DEARBORN ST
CHICAGO IL
60609-2910
US

V. Phone/Fax

Practice location:
  • Phone: 312-823-0886
  • Fax:
Mailing address:
  • Phone: 312-823-0886
  • Fax: 888-251-1030

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OLUMUYIDE OMOLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-823-0886