Healthcare Provider Details

I. General information

NPI: 1437556958
Provider Name (Legal Business Name): DIETITIANS AT HOME THERAPEUTIC SHOES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W FULTON ST
CHICAGO IL
60612-2345
US

IV. Provider business mailing address

2003 W FULTON ST
CHICAGO IL
60612-2345
US

V. Phone/Fax

Practice location:
  • Phone: 312-850-3434
  • Fax: 312-638-9872
Mailing address:
  • Phone: 312-850-3434
  • Fax: 312-638-9872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL

VIII. Authorized Official

Name: SUZANNE HALL
Title or Position: CFO
Credential:
Phone: 312-850-3438