Healthcare Provider Details

I. General information

NPI: 1366128316
Provider Name (Legal Business Name): WILSON UNLIMITED FAMILY ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 E 72ND PL APT 1
CHICAGO IL
60619
US

IV. Provider business mailing address

1333 E 72ND PL APT 1
CHICAGO IL
60619
US

V. Phone/Fax

Practice location:
  • Phone: 872-999-0043
  • Fax:
Mailing address:
  • Phone: 872-999-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAILYN WILSON
Title or Position: OWNER
Credential:
Phone: 872-999-0043