Healthcare Provider Details

I. General information

NPI: 1811507361
Provider Name (Legal Business Name): POTENTIAL UNLIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N OAKLEY AVE
CHICAGO IL
60625-1847
US

IV. Provider business mailing address

5140 N OAKLEY AVE
CHICAGO IL
60625-1847
US

V. Phone/Fax

Practice location:
  • Phone: 773-573-4443
  • Fax:
Mailing address:
  • Phone: 773-573-4443
  • 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: KAREN STANLEY
Title or Position: CEO
Credential: OT
Phone: 773-573-4443