Healthcare Provider Details

I. General information

NPI: 1346991627
Provider Name (Legal Business Name): NOSDUH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1721 E 67TH ST
CHICAGO IL
60649-5473
US

IV. Provider business mailing address

1721 E 67TH ST
CHICAGO IL
60649-5473
US

V. Phone/Fax

Practice location:
  • Phone: 312-481-1731
  • Fax:
Mailing address:
  • Phone: 312-481-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DENISE GRIFFIN
Title or Position: CEO
Credential:
Phone: 312-481-1731