Healthcare Provider Details

I. General information

NPI: 1720749856
Provider Name (Legal Business Name): VILLA HOLISTIC CAREGIVERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W DEVON AVE STE 412
CHICAGO IL
60646-4539
US

IV. Provider business mailing address

4001 W DEVON AVE STE 412
CHICAGO IL
60646-4539
US

V. Phone/Fax

Practice location:
  • Phone: 217-480-0375
  • Fax: 708-320-2883
Mailing address:
  • Phone: 217-480-0375
  • Fax: 708-320-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MWENYA MULENGA
Title or Position: CEO
Credential: RN
Phone: 217-480-0375