Healthcare Provider Details

I. General information

NPI: 1790476935
Provider Name (Legal Business Name): GLAM HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W DEVON AVE STE 100
CHICAGO IL
60659-1216
US

IV. Provider business mailing address

3601 W DEVON AVE STE 100
CHICAGO IL
60659-1216
US

V. Phone/Fax

Practice location:
  • Phone: 312-825-2477
  • Fax: 872-268-7993
Mailing address:
  • Phone: 312-825-2477
  • Fax: 872-268-7993

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LILLA DIRISU
Title or Position: MANAGER
Credential: RN
Phone: 773-739-3668