Healthcare Provider Details

I. General information

NPI: 1043961642
Provider Name (Legal Business Name): NURSES ON WHEELS HOMESERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 S MICHIGAN AVE STE 105
CHICAGO IL
60628-4308
US

IV. Provider business mailing address

11001 S MICHIGAN AVE STE 105
CHICAGO IL
60628-4308
US

V. Phone/Fax

Practice location:
  • Phone: 773-313-9040
  • Fax:
Mailing address:
  • Phone: 773-313-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral 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 Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALESIA BOYD CARLOCK
Title or Position: DIRECTOR
Credential:
Phone: 773-313-9040