Healthcare Provider Details

I. General information

NPI: 1760991285
Provider Name (Legal Business Name): A.B.R.A.M. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 S EMERALD AVE
CHICAGO IL
60621-2509
US

IV. Provider business mailing address

P.O. BOX 21904 6751 SO. EMERALD
CHICAGO IL
60621-2509
US

V. Phone/Fax

Practice location:
  • Phone: 773-488-2887
  • Fax:
Mailing address:
  • Phone: 773-488-2887
  • 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 TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberW252-1617-3197
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049122123
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DARON ANTHONY WASHINGTON
Title or Position: DIRECTOR & PRESIDENT
Credential: PH. T
Phone: 773-488-2887