Healthcare Provider Details

I. General information

NPI: 1801262522
Provider Name (Legal Business Name): TOTAL HEALTHCARE/AMERICA'S DISABLED-PHYSICIAN HOME VISITS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5906 N MILWAUKEE AVE
CHICAGO IL
60646-5420
US

IV. Provider business mailing address

5906 N MILWAUKEE AVE
CHICAGO IL
60646-5420
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIL

VIII. Authorized Official

Name: LATOYA L ROBINSON
Title or Position: FNP-C
Credential:
Phone: 708-539-4995