Healthcare Provider Details

I. General information

NPI: 1912896499
Provider Name (Legal Business Name): BLUEOAK HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N CLINTON ST STE 2N
CHICAGO IL
60661-1283
US

IV. Provider business mailing address

211 N CLINTON ST STE 2N
CHICAGO IL
60661-1283
US

V. Phone/Fax

Practice location:
  • Phone: 678-693-0146
  • Fax:
Mailing address:
  • Phone: 678-693-0146
  • 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: ADEMOLA ADEREMI AZEEZ
Title or Position: CEO
Credential:
Phone: 678-693-0146