Healthcare Provider Details

I. General information

NPI: 1114381662
Provider Name (Legal Business Name): FSJN ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W BERTEAU AVE STE 202
CHICAGO IL
60613-6182
US

IV. Provider business mailing address

1802 W BERTEAU AVE STE 202
CHICAGO IL
60613-6182
US

V. Phone/Fax

Practice location:
  • Phone: 630-802-7556
  • Fax:
Mailing address:
  • Phone: 773-868-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3001394
License Number StateIL

VIII. Authorized Official

Name: FRANK SHANNON
Title or Position: OWNER
Credential:
Phone: 773-868-3183