Healthcare Provider Details

I. General information

NPI: 1376194845
Provider Name (Legal Business Name): INDEPENDENCE CARE OF CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N MICHIGAN AVE STE 1400
CHICAGO IL
60611-4500
US

IV. Provider business mailing address

950 N MICHIGAN AVE STE 1400
CHICAGO IL
60611-4500
US

V. Phone/Fax

Practice location:
  • Phone: 917-733-1135
  • Fax:
Mailing address:
  • Phone: 917-733-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALLISON VIAR
Title or Position: OWNER
Credential:
Phone: 917-733-1135