Healthcare Provider Details

I. General information

NPI: 1821763947
Provider Name (Legal Business Name): CONRAD CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 W PETERSON AVE STE 505
CHICAGO IL
60659-3317
US

IV. Provider business mailing address

23 STIRLING LN APT 1822
WILLOWBROOK IL
60527-3181
US

V. Phone/Fax

Practice location:
  • Phone: 773-240-9225
  • Fax:
Mailing address:
  • Phone: 773-240-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS AGBONIFO
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-240-9225